1457319469 NPI number — WAKEEM INC

Table of content: (NPI 1457319469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457319469 NPI number — WAKEEM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAKEEM INC
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:
BELL APOTHECARY
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:
1457319469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2045 FAIRVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-258-2311
Provider Business Mailing Address Fax Number:
610-252-0972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2045 FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-258-2311
Provider Business Practice Location Address Fax Number:
610-252-0972
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ISAAC
Authorized Official First Name:
MARYANN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
610-258-2311

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 283036 . This is a "OTHER MICELLANEOUS INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39HA31 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80530 . This is a "UNISON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0010448410001 . This is a "PA MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1404974 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0010448410001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0010448410001 . This is a "PA WAIVER PROGRAM" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com