1124143532 NPI number — NORTHMED COMPOUNDING PHARMACY

Table of content: (NPI 1124143532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124143532 NPI number — NORTHMED COMPOUNDING PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHMED COMPOUNDING PHARMACY
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:
Provider Other Organization Name Type Code:
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:
1124143532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 W CHISHOLM ST
Provider Second Line Business Mailing Address:
UNIT-A
Provider Business Mailing Address City Name:
ALPENA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49707-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-354-3189
Provider Business Mailing Address Fax Number:
989-354-3286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1202 W CHISHOLM ST
Provider Second Line Business Practice Location Address:
UNIT-A
Provider Business Practice Location Address City Name:
ALPENA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49707-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-354-3189
Provider Business Practice Location Address Fax Number:
989-354-3286
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRAFT
Authorized Official First Name:
KASSI
Authorized Official Middle Name:
Authorized Official Title or Position:
DME MANAGER, PHARMACY TECHNICIAN
Authorized Official Telephone Number:
989-354-3189

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X , with the licence number:  5301008061 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5301008061 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2366753 . This is a "NCPDP#" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com