1023464831 NPI number — MAXOR NATIONAL PHARMACY SERVICES LLC

Table of content: (NPI 1023464831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023464831 NPI number — MAXOR NATIONAL PHARMACY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAXOR NATIONAL PHARMACY SERVICES 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:
BRIGHTPOINT 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:
1023464831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 S POLK ST STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79101-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-242-7782
Provider Business Mailing Address Fax Number:
718-362-1236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1543 INWOOD AVE
Provider Second Line Business Practice Location Address:
THIRD FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10452-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-208-2837
Provider Business Practice Location Address Fax Number:
718-362-1236
Provider Enumeration Date:
05/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT PHARMACY SERVICES
Authorized Official Telephone Number:
806-242-7782

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: 034570 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04167671 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2160354 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com