1144433525 NPI number — MR. PETERF J KWASNIK RPH

Table of content: MR. PETERF J KWASNIK RPH (NPI 1144433525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144433525 NPI number — MR. PETERF J KWASNIK RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KWASNIK
Provider First Name:
PETERF
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

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:
1144433525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 SOUTH BROAD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-334-2431
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 STONE HOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERBURNE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-334-2431
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  26287 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26287 . This is a "PHARMACY STATE LIC." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".