1922389618 NPI number — ST BARNABAS PHARMACY

Table of content: (NPI 1922389618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922389618 NPI number — ST BARNABAS PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST BARNABAS PHARMACY
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:
ST.BARNABAS 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:
1922389618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4311 ST.BARNABAS RD,
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE HILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-456-2471
Provider Business Mailing Address Fax Number:
301-456-2473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4311 SAINT BARNABAS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE HILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20748-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-456-2471
Provider Business Practice Location Address Fax Number:
301-456-2473
Provider Enumeration Date:
09/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EZEKWU
Authorized Official First Name:
ETHELBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
248-996-3441

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 05595 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2132009 . This is a "PK" identifier . This identifiers is of the category "OTHER".