1073645008 NPI number — NATIONAL PHARMACY ACQUISTION LLC

Table of content: (NPI 1073645008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073645008 NPI number — NATIONAL PHARMACY ACQUISTION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL PHARMACY ACQUISTION 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:
NATIONAL INFUSION SERVICES
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:
1073645008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5344 BRITTANY DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70808-4344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-766-7828
Provider Business Mailing Address Fax Number:
225-766-7830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5344 BRITTANY DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-4344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-766-7828
Provider Business Practice Location Address Fax Number:
225-766-7830
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEBOUEF
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
225-766-7828

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 4663 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2035288 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1268691 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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