1073757852 NPI number — NORTHWEST MEDICAL PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073757852 NPI number — NORTHWEST MEDICAL PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST MEDICAL PHARMACY
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:
6
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:
1073757852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
671 NW 119TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33168-2522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-582-3602
Provider Business Mailing Address Fax Number:
866-396-9179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
671 NW 119TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33168-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-582-3602
Provider Business Practice Location Address Fax Number:
866-396-9179
Provider Enumeration Date:
04/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
ERNESTO
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
305-651-7074

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PH24054 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053432 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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