1134559172 NPI number — MERCURY HEALTH, INC

Table of content: (NPI 1134559172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134559172 NPI number — MERCURY HEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCURY HEALTH, 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:
MERCURY PHARMACY
Provider Other Organization Name Type Code:
5
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:
1134559172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1420 E PLAZA BLVD
Provider Second Line Business Mailing Address:
STE B-3
Provider Business Mailing Address City Name:
NATIONAL CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91950-3636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-565-9707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1420 E PLAZA BLVD
Provider Second Line Business Practice Location Address:
STE B-3
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-3636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-565-9707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KHALIL
Authorized Official First Name:
NABIL
Authorized Official Middle Name:
TAWFIK IBRAHIM
Authorized Official Title or Position:
OWNER/ PRESIDENT
Authorized Official Telephone Number:
619-565-9707

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  51620 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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