1386984771 NPI number — PHARMBLUE LLC

Table of content: (NPI 1386984771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386984771 NPI number — PHARMBLUE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMBLUE LLC
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:
PHARMBLUE LLC
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:
1386984771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 645050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15264-5050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-779-4720
Provider Business Mailing Address Fax Number:
855-779-4721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 PENNWOOD PL STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15086-6526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-779-4720
Provider Business Practice Location Address Fax Number:
724-779-4721
Provider Enumeration Date:
02/21/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CEO/AO
Authorized Official Telephone Number:
724-779-4720

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  A9-0001259 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 22-13036 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: NRX0000260 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: OSP.0006224 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PMP854 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PA1671 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 22299MS , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PCN.0002541 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH27097 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 64001499A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 4214 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 054.018350 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHNR000016 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 1495 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHAO1275 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10026562700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3096207 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500689502 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386984771 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102811091 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386984771 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48076554 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386984771 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152103 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82828501 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386984771 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386984771 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2139860 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 70409100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7P2344 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".