1235197773 NPI number — PHARMA-CARD WEST, INC

Table of content: (NPI 1235197773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235197773 NPI number — PHARMA-CARD WEST, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMA-CARD WEST, 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:
PHARMA-CARD HAMMOND
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:
1235197773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALPARAISO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46384-1637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-464-0404
Provider Business Mailing Address Fax Number:
219-465-0333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 HOHMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46320-1965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-932-2920
Provider Business Practice Location Address Fax Number:
219-933-2194
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRYCHELL
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-464-0404

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  60005324A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 351712881001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com