1952316572 NPI number — SHIPMANS PHARMACY INC

Table of content: (NPI 1952316572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952316572 NPI number — SHIPMANS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIPMANS PHARMACY 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:
HENRY CUNNINGHAM
Provider Other Organization Name Type Code:
4
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:
1952316572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 S FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEMPSTEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11550-5613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-483-1767
Provider Business Mailing Address Fax Number:
516-481-4905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 S FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMPSTEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11550-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-483-1767
Provider Business Practice Location Address Fax Number:
516-481-4905
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CUNNINGHAM
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
516-483-1767

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3394462 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3394462 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07487396 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".