1215206263 NPI number — QMP PHARMACY LLC

Table of content: (NPI 1215206263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215206263 NPI number — QMP PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QMP 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:
Provider Other Organization Name Type Code:
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:
1215206263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5180 W ATLANTIC AVE
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33484-8103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-767-0874
Provider Business Mailing Address Fax Number:
888-716-6567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41095-9300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-767-0874
Provider Business Practice Location Address Fax Number:
888-716-6567
Provider Enumeration Date:
12/20/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SOBLICK
Authorized Official First Name:
JORDAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
800-767-0874

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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