1679659726 NPI number — DOUGIE FRESH INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679659726 NPI number — DOUGIE FRESH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGIE FRESH 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:
HAEUN 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:
1679659726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7300 OLD YORK RD
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
MELROSE PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027-3037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-635-6532
Provider Business Mailing Address Fax Number:
215-635-2745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 OLD YORK RD
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
MELROSE PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-635-6532
Provider Business Practice Location Address Fax Number:
215-635-2745
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
DEOG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-635-6532

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: PP481283 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1027895800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2138837 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com