1659375210 NPI number — WAKEEM INC

Table of content: (NPI 1659375210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659375210 NPI number — WAKEEM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAKEEM 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:
BELL APOTHECARY
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:
1659375210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2045 FAIRVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042-3915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-258-2311
Provider Business Mailing Address Fax Number:
610-252-0972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2045 FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-258-2311
Provider Business Practice Location Address Fax Number:
610-252-0972
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ISAAC
Authorized Official First Name:
MARYANNE.
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PHARMACIST OWNER
Authorized Official Telephone Number:
610-258-2311

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PP412543L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3928629 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1523031 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 80530 . This is a "MED PLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39HA31 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HIGHMARK . This is a "DME INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0010448410001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2830306 . This is a "ALL OTHER INSURANCE" identifier . This identifiers is of the category "OTHER".




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