1134286529 NPI number — HOMEBOUND SOLUTIONS PHARMACY LLC

Table of content: (NPI 1134286529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134286529 NPI number — HOMEBOUND SOLUTIONS PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMEBOUND SOLUTIONS PHARMACY 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:
JAMAICA 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:
1134286529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1274 49TH ST
Provider Second Line Business Mailing Address:
STE 157
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11219-3011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13506 JAMAICA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11418-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-291-6061
Provider Business Practice Location Address Fax Number:
718-291-6063
Provider Enumeration Date:
01/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERNATH
Authorized Official First Name:
JACK
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
718-744-5020

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  028925 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3350270 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02966892 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".