1366592602 NPI number — L M CALDWELL PHARMACIST INC

Table of content: (NPI 1366592602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366592602 NPI number — L M CALDWELL PHARMACIST INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L M CALDWELL PHARMACIST 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:
L M CALDWELL PHARMACIST
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:
1366592602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 W PUEBLO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93105-3892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-682-7353
Provider Business Mailing Address Fax Number:
805-563-2549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 W PUEBLO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93105-3892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-682-7353
Provider Business Practice Location Address Fax Number:
805-563-2549
Provider Enumeration Date:
01/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CALDWELL
Authorized Official First Name:
PETER
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
805-965-4528

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY30912 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHA199620 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0547072 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".