1760554554 NPI number — HEALTH SYSTEMS UNITED INC

Table of content: DR. KAYLA LYNN WHITSON MD (NPI 1700349040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760554554 NPI number — HEALTH SYSTEMS UNITED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH SYSTEMS UNITED 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:
MEDICINE SHOPPE
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:
1760554554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AYER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01432-1339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AYER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01432-1339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-772-7325
Provider Business Practice Location Address Fax Number:
978-772-5119
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASTIEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PHARMACIST
Authorized Official Telephone Number:
978-772-7325

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  2793 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0406742 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2237015 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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