1134335201 NPI number — BRAY PHARMACY INC

Table of content: (NPI 1134335201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134335201 NPI number — BRAY PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAY PHARMACY INC
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:
CAPITAL PHARMACY AND MEDICAL EQUIPMENT
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:
1134335201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
662 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40601-2338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-223-2827
Provider Business Mailing Address Fax Number:
502-227-2026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
662 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-223-2827
Provider Business Practice Location Address Fax Number:
502-227-2026
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCINTOSH
Authorized Official First Name:
AARON
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-223-2827

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1186150001 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 9000882200 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 1186150001 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 9000882200 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 1186150001 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 9000882200 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 1186150001 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 9000882200 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 1186150001 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 9000882200 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 18D0968102 . This is a "CLIA CERTIFICATION" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 9000882200 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01908 . This is a "STORE KY LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: MG0158 . This is a "KY MED GAS LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com