1356406474 NPI number — SIERRA INTERNATIONAL PHARMACEUTICAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356406474 NPI number — SIERRA INTERNATIONAL PHARMACEUTICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIERRA INTERNATIONAL PHARMACEUTICAL
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:
1356406474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3316 14TH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20010-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-232-1455
Provider Business Mailing Address Fax Number:
202-232-1453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3316 14TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-232-1455
Provider Business Practice Location Address Fax Number:
202-232-1453
Provider Enumeration Date:
12/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOCKAI
Authorized Official First Name:
SAHR
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST OWNER
Authorized Official Telephone Number:
202-232-1455

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  RX9300229 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 025933200 . This is a "DME NUMBER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 017026400 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".