1265549547 NPI number — JOSEPH H CARSTARPHEN

Table of content: (NPI 1265549547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265549547 NPI number — JOSEPH H CARSTARPHEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH H CARSTARPHEN
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:
INTERLINK DRUG COMPANY
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:
1265549547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2050
Provider Second Line Business Mailing Address:
618 MEDICAL CENTER PARKWAY SUITE B
Provider Business Mailing Address City Name:
SELMA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36702-2050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-875-7686
Provider Business Mailing Address Fax Number:
334-875-7687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
618 MEDICAL CENTER PARKWAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36702-2050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-875-7686
Provider Business Practice Location Address Fax Number:
334-875-7687
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARSTARPHEN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PHARMACIST OWNER
Authorized Official Telephone Number:
334-875-7686

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  105490 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100001915 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0109593 . This is a "NABP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com