1598878936 NPI number — PRICE CHOPPER INC

Table of content: (NPI 1598878936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598878936 NPI number — PRICE CHOPPER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRICE CHOPPER 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:
PRICE CHOPPER 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:
1598878936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
461 NOTT ST
Provider Second Line Business Mailing Address:
MB#202
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12308-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-379-1618
Provider Business Mailing Address Fax Number:
518-356-6978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 TALCOTTVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06066-5261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-875-1211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRYANT
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PHARMACY
Authorized Official Telephone Number:
518-379-1122

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PCY.0001913 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2002636 . This is a "PK" identifier . This identifiers is of the category "OTHER".