1720114135 NPI number — WILLIAMS APOTHECARY INC

Table of content: (NPI 1720114135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720114135 NPI number — WILLIAMS APOTHECARY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMS APOTHECARY 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:
WILLIAMS 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:
1720114135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 E OREGON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITITZ
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17543-9205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-581-3950
Provider Business Mailing Address Fax Number:
717-581-3952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 E OREGON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITITZ
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17543-9205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-581-3950
Provider Business Practice Location Address Fax Number:
717-581-3952
Provider Enumeration Date:
02/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
717-393-3814

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PP415122L , 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: 3974195 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0011272920003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".