1295051845 NPI number — ASHWINI HEALTHCARE LLC

Table of content: (NPI 1295051845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295051845 NPI number — ASHWINI HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHWINI HEALTHCARE LLC
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:
MELBOURNE DISCOUNT 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:
1295051845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
816 AUTUMN GLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32940-6423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-752-9125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N WICKHAM RD
Provider Second Line Business Practice Location Address:
SUITE W AND X
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935-8659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-751-7885
Provider Business Practice Location Address Fax Number:
321-751-7886
Provider Enumeration Date:
04/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
THIMMEGOWDA
Authorized Official First Name:
MANASA
Authorized Official Middle Name:
Authorized Official Title or Position:
MGRM
Authorized Official Telephone Number:
321-752-9125

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH24577 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002560400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1055703 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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