1942443254 NPI number — MJW CORPORATION

Table of content: (NPI 1942443254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942443254 NPI number — MJW CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MJW CORPORATION
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:
FAMILY PHARMACY-SOUTH AIKEN DME
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:
1942443254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 GOOD HOPE FARMS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29803-6933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-599-1776
Provider Business Mailing Address Fax Number:
803-649-7381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 PRICE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29803-7395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-648-1776
Provider Business Practice Location Address Fax Number:
803-649-7381
Provider Enumeration Date:
04/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WATTS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PHARMACIST OWNER
Authorized Official Telephone Number:
803-599-1776

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5010379 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5010379 . This is a "SC PHARMACY PERMIT" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com