1245210434 NPI number — ROCK CREEK PHARMACY, INC.

Table of content: (NPI 1245210434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245210434 NPI number — ROCK CREEK PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCK CREEK 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:
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:
1245210434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6817 WARRIOR RIVER RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BESSEMER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35023-5602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-497-8777
Provider Business Mailing Address Fax Number:
205-497-8797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6799 WARRIOR RIVER RD
Provider Second Line Business Practice Location Address:
STE.101
Provider Business Practice Location Address City Name:
BESSEMER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35023-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-497-8777
Provider Business Practice Location Address Fax Number:
205-497-8797
Provider Enumeration Date:
01/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDERS
Authorized Official First Name:
TERI
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
205-497-8777

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7866190001 . This is a "MEDICARE DME" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 112692 . This is a "STATE LICENSE #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: Q123610001 . This is a "IMMUNIZATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100003639 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".