1114065596 NPI number — RPHC LLC

Table of content: JOSEPH AMERICO M FERNANDES JR. MD (NPI 1770535619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114065596 NPI number — RPHC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RPHC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REEDS PHARMACY 3
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114065596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
343 N PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANCOCK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21750-1046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-678-2930
Provider Business Mailing Address Fax Number:
301-678-2932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
343 N PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANCOCK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21750-1046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-678-2930
Provider Business Practice Location Address Fax Number:
301-678-2932
Provider Enumeration Date:
02/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HATCHER
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
301-678-2932

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PO4323 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005492500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1015233400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810003576 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".