1457423972 NPI number — PATIENT CARE PHARMACY SERVICES INC

Table of content: (NPI 1457423972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457423972 NPI number — PATIENT CARE PHARMACY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENT CARE PHARMACY SERVICES 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:
PATIENT CARE PHARMACY SERVICES
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:
1457423972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1476 MARKET CIR
Provider Second Line Business Mailing Address:
UNIT 1
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33953-3876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-255-1987
Provider Business Mailing Address Fax Number:
941-629-5507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1476 MARKET CIR
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33953-3876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-255-1987
Provider Business Practice Location Address Fax Number:
941-629-5507
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
941-255-1987

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PH17469 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 022734000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2013630 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com