1083635270 NPI number — CI PHARMACY SERVICES LTD

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 1083635270 NPI number — CI PHARMACY SERVICES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CI PHARMACY SERVICES LTD
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:
GUIDEPOINT 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:
1083635270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 S 6TH ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
BRAINERD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56401-3575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-829-0347
Provider Business Mailing Address Fax Number:
218-829-4701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSBY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56441-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-546-5144
Provider Business Practice Location Address Fax Number:
218-546-7238
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZWALD
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/VP
Authorized Official Telephone Number:
218-829-0347

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: 263734 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1083635270 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 951262400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2420925 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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