1053482075 NPI number — LEVANDOWSKI, LLC

Table of content: (NPI 1053482075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053482075 NPI number — LEVANDOWSKI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEVANDOWSKI, 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:
ATLAS DRUGS
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:
1053482075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1619 W GRAND RIVER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48864-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-347-1458
Provider Business Mailing Address Fax Number:
517-347-2449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1619 W GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-347-1458
Provider Business Practice Location Address Fax Number:
517-347-2449
Provider Enumeration Date:
11/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HELMICK
Authorized Official First Name:
CALVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR OF PHRMCY
Authorized Official Telephone Number:
577-887-1877

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 5301006733 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2357906 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".