1386125821 NPI number — CI PHARMACY SERVICES, LTD

Table of content: (NPI 1386125821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386125821 NPI number — CI PHARMACY SERVICES, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CI PHARMACY SERVICES, LTD
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:
GUIDEPOINT PHARMACY #106 LTC
Provider Other Organization Name Type Code:
5
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:
1386125821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14091 BAXTER DR STE 201B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAXTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56425-8835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-829-3476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSBY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56441-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-546-5144
Provider Business Practice Location Address Fax Number:
218-546-7238
Provider Enumeration Date:
08/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZWALD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
218-829-0347

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  263734 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1083635270 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 263734 . This is a "STATE PHARMACY LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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