1982619532 NPI number — BUCKLEY FOODS INC

Table of content: (NPI 1982619532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982619532 NPI number — BUCKLEY FOODS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUCKLEY FOODS 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:
THE PRESCRIPTION SHOPPE
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:
1982619532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESQUE ISLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04769-2240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESQUE ISLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04769-2240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-764-4783
Provider Business Practice Location Address Fax Number:
207-764-7342
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASSIDY
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
PHCY MNGR
Authorized Official Telephone Number:
207-762-0101

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH50000734 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 734 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004644 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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