1538469028 NPI number — FOSUYI ENTERPRISE

Table of content: (NPI 1538469028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538469028 NPI number — FOSUYI ENTERPRISE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOSUYI ENTERPRISE
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:
RITE-MART PHARMACY
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:
1538469028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2595 WATERMILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-1621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-505-9720
Provider Business Mailing Address Fax Number:
904-693-6684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5312 N PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32208-5119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-353-7223
Provider Business Practice Location Address Fax Number:
904-353-7224
Provider Enumeration Date:
10/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
OBASUYI
Authorized Official First Name:
FELIX
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
904-353-7223

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH25006 , 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: 5702382 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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