1194919464 NPI number — NICOLE AND ANDRE PHARMACEUTICAL INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194919464 NPI number — NICOLE AND ANDRE PHARMACEUTICAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NICOLE AND ANDRE PHARMACEUTICAL 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:
IMPERIAL MEDICAL SUPPLIES
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:
1194919464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9209 COLIMA RD STE 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITTIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90605-1863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-789-5852
Provider Business Mailing Address Fax Number:
562-789-5854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 W MAIN ST STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-789-5852
Provider Business Practice Location Address Fax Number:
562-789-5854
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KHALIL
Authorized Official First Name:
ODETTE
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
562-789-5852

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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