1063792018 NPI number — HAYDEN FAMILY PHARMACY P C

Table of content: (NPI 1063792018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063792018 NPI number — HAYDEN FAMILY PHARMACY P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAYDEN FAMILY PHARMACY P C
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:
SHIPP'S DISCOUNT 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:
1063792018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 665
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35079-0665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-590-1100
Provider Business Mailing Address Fax Number:
205-590-1120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 WHITE OAK TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRIOR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35180-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-590-1100
Provider Business Practice Location Address Fax Number:
205-590-1120
Provider Enumeration Date:
08/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
METCALF
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-590-1100

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: 113797 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01D2107084 . This is a "CLIA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2131605 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1063792018 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com