1487965018 NPI number — PHARMAKON LLC

Table of content: (NPI 1487965018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487965018 NPI number — PHARMAKON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMAKON 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:
DUVAL PHARMACY
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:
1487965018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2386 DUNN AVE
Provider Second Line Business Mailing Address:
SUITE #117
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32218-4602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-696-8882
Provider Business Mailing Address Fax Number:
904-696-9982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2386 DUNN AVE
Provider Second Line Business Practice Location Address:
SUITE #117
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32218-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-696-8882
Provider Business Practice Location Address Fax Number:
904-696-9982
Provider Enumeration Date:
06/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
DARSHAN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
M.M.
Authorized Official Telephone Number:
912-571-2754

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH 24721 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002748000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002748001 . This is a "MEDICAID - DME" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: HN481A . This is a "MEDICARE NSC - IMMUNIZAITON" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com