1144557828 NPI number — ALANA HEALTHCARE PHARMACY

Table of content: (NPI 1144557828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144557828 NPI number — ALANA HEALTHCARE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALANA HEALTHCARE 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:
ALANA HEALTHCARE PHARMACY
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:
1144557828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1469
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DICKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37056-1469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-375-1094
Provider Business Mailing Address Fax Number:
615-375-1132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
636 DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-4654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-375-1094
Provider Business Practice Location Address Fax Number:
877-471-2484
Provider Enumeration Date:
11/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
MAGGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PHARMACY OPS
Authorized Official Telephone Number:
615-375-1094

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 4701 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 80535364 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144557828 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4442808 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200982350A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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