1316115413 NPI number — GETTYS CORP LLP

Table of content: (NPI 1316115413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316115413 NPI number — GETTYS CORP LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GETTYS CORP LLP
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:
PATHWAY SPECIALTY COMPOUNDS
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:
1316115413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/27/2012
NPI Reactivation Date:
10/10/2012

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2560 E SUNSET RD
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-541-6023
Provider Business Mailing Address Fax Number:
702-405-8135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2560 E SUNSET RD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-541-6023
Provider Business Practice Location Address Fax Number:
702-405-8135
Provider Enumeration Date:
02/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILD
Authorized Official First Name:
DARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
702-541-6023

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH02590 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X , with the licence number: PH02340 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2990794 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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