1194881599 NPI number — S & S PHARMACY INC

Table of content: (NPI 1194881599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194881599 NPI number — S & S PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S & S PHARMACY INC
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:
PLATINUM PHARMACY AND COMPOUND
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:
1194881599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14973 BRUCE B DOWNS BLVD
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-866-5000
Provider Business Mailing Address Fax Number:
813-866-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14973 BRUCE B DOWNS BLVD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613-2860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-866-5000
Provider Business Practice Location Address Fax Number:
813-866-5001
Provider Enumeration Date:
12/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARSOUM
Authorized Official First Name:
IHAB
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND PHCY MGR
Authorized Official Telephone Number:
813-766-9955

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH22447 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1023984 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".