1396753877 NPI number — JOSEPH A LANZON RPH PC

Table of content: (NPI 1396753877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396753877 NPI number — JOSEPH A LANZON RPH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH A LANZON RPH PC
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:
PROFESSIONAL VILLAGE PHARMACY OF LIVONIA
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:
1396753877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11589 FARMINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48150-5729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-427-2400
Provider Business Mailing Address Fax Number:
734-261-6139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11589 FARMINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48150-5729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-427-2400
Provider Business Practice Location Address Fax Number:
734-261-6139
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UDDIN
Authorized Official First Name:
AAMIR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-427-2400

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301004975 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2040502 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2915057 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2915066 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com