1053488411 NPI number — BROWNSVILLE APOTHECARY, INC.

Table of content: MRS. ALYSSA BAILEY MCGRATH LCSW (NPI 1770764094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053488411 NPI number — BROWNSVILLE APOTHECARY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWNSVILLE APOTHECARY, 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:
Provider Other Organization Name Type Code:
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:
1053488411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2565 N WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38012-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-772-5238
Provider Business Mailing Address Fax Number:
731-772-4651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2565 N WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38012-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-772-5238
Provider Business Practice Location Address Fax Number:
731-772-4651
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
731-772-5238

Provider Taxonomy Codes

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

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

  • Identifier: 4418263 . This is a "NABP" identifier . This identifiers is of the category "OTHER".




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