1346534476 NPI number — IKINYA LLC

Table of content: DR. AIMEE VAUGHN DVM CVA (NPI 1033562855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346534476 NPI number — IKINYA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IKINYA 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:
Provider Other Organization Name Type Code:
6
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:
1346534476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20700 BOND RD NE STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POULSBO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98370-9099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-930-8264
Provider Business Mailing Address Fax Number:
360-930-8962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20700 BOND RD NE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-9099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-930-8264
Provider Business Practice Location Address Fax Number:
360-930-8962
Provider Enumeration Date:
06/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SARVAIYA
Authorized Official First Name:
INDRAJEETSINH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY OWNER
Authorized Official Telephone Number:
360-674-8153

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  60215564 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4934041 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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