1306832308 NPI number — LENOX PHARMACY

Table of content: (NPI 1306832308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306832308 NPI number — LENOX PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LENOX PHARMACY
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:
1306832308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5879 SR 92
Provider Second Line Business Mailing Address:
SUITE 3 LENOX PLAZA
Provider Business Mailing Address City Name:
KINGSLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18826-9751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-222-5005
Provider Business Mailing Address Fax Number:
570-222-5006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5879 SR 92
Provider Second Line Business Practice Location Address:
SUITE 3 LENOX PLAZA
Provider Business Practice Location Address City Name:
KINGSLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18826-9751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-222-5005
Provider Business Practice Location Address Fax Number:
570-222-5006
Provider Enumeration Date:
09/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MULLER
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-222-5005

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PP414982L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0014984970001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com