1093231474 NPI number — CREATIVE PHARMACY SOLUTIONS CENTRAL, LLC

Table of content: (NPI 1093231474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093231474 NPI number — CREATIVE PHARMACY SOLUTIONS CENTRAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE PHARMACY SOLUTIONS CENTRAL, 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:
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:
1093231474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2535 JOHNS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14701-9210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-720-5121
Provider Business Mailing Address Fax Number:
716-708-6248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 PRIMOS AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLCROFT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19032-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-522-9006
Provider Business Practice Location Address Fax Number:
610-522-9088
Provider Enumeration Date:
08/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MOON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-720-5121

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP482153 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com