1245364165 NPI number — OC PHARMA, INC

Table of content: (NPI 1245364165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245364165 NPI number — OC PHARMA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OC PHARMA, 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:
COASTAL DRUG CENTER HEALTH MART
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:
1245364165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12312 SAVANNA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISHOPVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21813-1686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-352-3664
Provider Business Mailing Address Fax Number:
410-352-5654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10231 OLD OCEAN CITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 103, JAMES G. BARRETT MEDICAL BLDG
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-629-0071
Provider Business Practice Location Address Fax Number:
410-629-0081
Provider Enumeration Date:
03/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARCALUS
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
SECRETARY, PHARMACIST
Authorized Official Telephone Number:
410-352-3664

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PENDING , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2133483 . This is a "NCPDP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".