1144556770 NPI number — MPS RX NEW ENGLAND LLC

Table of content: (NPI 1144556770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144556770 NPI number — MPS RX NEW ENGLAND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MPS RX NEW ENGLAND 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:
MILLENNIUM 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:
1144556770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E KENSINGER DR
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
CRANBERRY TOWNSHIP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16066-3556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-466-7779
Provider Business Mailing Address Fax Number:
877-295-7772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33B APPIAN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02917-1777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-940-2490
Provider Business Practice Location Address Fax Number:
877-295-7772
Provider Enumeration Date:
11/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MCKILLIP
Authorized Official First Name:
RON
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, BUSINESS SYSTEMS SUPPORT
Authorized Official Telephone Number:
724-940-2819

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHA00516 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2122633 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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