1992817837 NPI number — MHAJ INVESTMENTS LLC

Table of content: (NPI 1992817837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992817837 NPI number — MHAJ INVESTMENTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MHAJ INVESTMENTS LLC
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:
NATHAN 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:
1992817837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6420 N CALIFORNIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60645-5253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-973-6107
Provider Business Mailing Address Fax Number:
773-973-7580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 N CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60645-5253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-973-6107
Provider Business Practice Location Address Fax Number:
773-973-7580
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHLOSS DE BRIHUEGA
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
773-973-6107

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: 054009882 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2019302 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 363707788001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".