1396938049 NPI number — GLENN F SCHIFF R.PH.

Table of content: GLENN F SCHIFF R.PH. (NPI 1396938049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396938049 NPI number — GLENN F SCHIFF R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHIFF
Provider First Name:
GLENN
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1396938049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2088
Provider Second Line Business Mailing Address:
201 THIRD AVE, STE 201
Provider Business Mailing Address City Name:
SEWARD
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99664-2088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-224-3490
Provider Business Mailing Address Fax Number:
907-224-5870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 THIRD AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SEWARD
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99664-2088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-224-3490
Provider Business Practice Location Address Fax Number:
907-224-5870
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  1613 , 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: CL3490 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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