1235291121 NPI number — M.W.ALLEN PHARMACY INC.

Table of content: (NPI 1235291121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235291121 NPI number — M.W.ALLEN PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M.W.ALLEN PHARMACY 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:
VILLAGE HEALTHMART 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:
1235291121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
932 N STATE HIGHWAY 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65020-2648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-346-3396
Provider Business Mailing Address Fax Number:
573-346-5257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
932 N STATE HIGHWAY 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65020-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-346-3396
Provider Business Practice Location Address Fax Number:
573-346-5257
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-346-3396

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  004583 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 600659700 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620659706 . This is a "MEDICAID DME" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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