1801983101 NPI number — PHARMACYWORX INC

Table of content: (NPI 1801983101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801983101 NPI number — PHARMACYWORX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACYWORX 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:
OJAI VILLAGE 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:
1801983101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 E OJAI AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OJAI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93023-2737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-646-7272
Provider Business Mailing Address Fax Number:
805-646-1614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 E OJAI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OJAI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93023-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-646-7272
Provider Business Practice Location Address Fax Number:
805-646-1614
Provider Enumeration Date:
10/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LABROSSE
Authorized Official First Name:
KINGSLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
805-646-7272

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1801983101 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2125021 . This is a "PK" identifier . This identifiers is of the category "OTHER".