1780639633 NPI number — JOHN M BOVE

Table of content: (NPI 1780639633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780639633 NPI number — JOHN M BOVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN M BOVE
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:
GERICARE 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:
1780639633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/10/2008
NPI Reactivation Date:
08/04/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1852
Provider Second Line Business Mailing Address:
STATION A, GERICARE
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-1852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-773-3888
Provider Business Mailing Address Fax Number:
802-775-7400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 MENDON VIEW DRIVE
Provider Second Line Business Practice Location Address:
GERICARE
Provider Business Practice Location Address City Name:
MENDON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-773-3888
Provider Business Practice Location Address Fax Number:
802-775-7400
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABATIELL-BOVE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PHARMACIST MANAGER
Authorized Official Telephone Number:
802-773-3888

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  038-0003319 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 038-0003319 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 038-0003319 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 0380003319 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 47-03799 . This is a "NCPDP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 038-0003319 . This is a "PHARMACY LIC" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 4703799 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 038-0003319 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1007643 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com