1902981806 NPI number — OCEAN SHORES PHARMACY PS

Table of content: DR. KEITH LEONARD KAUFFMAN DC (NPI 1669507067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902981806 NPI number — OCEAN SHORES PHARMACY PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN SHORES PHARMACY PS
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:
Provider Other Organization Name Type Code:
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:
1902981806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1659
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN SHORES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98569-1659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-289-4647
Provider Business Mailing Address Fax Number:
360-289-3812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 E CHANCE A LA MER NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN SHORES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98569-9419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-289-4647
Provider Business Practice Location Address Fax Number:
360-289-3812
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCARTY
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-289-4647

Provider Taxonomy Codes

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

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

  • Identifier: 6140107 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com