1497724884 NPI number — SHINER FAMILY PHARMACY, INC

Table of content: (NPI 1497724884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497724884 NPI number — SHINER FAMILY PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHINER FAMILY PHARMACY, 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:
Provider Other Organization Name Type Code:
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:
1497724884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 N. AVE B
Provider Second Line Business Mailing Address:
P.O. BOX 666
Provider Business Mailing Address City Name:
SHINER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-594-2394
Provider Business Mailing Address Fax Number:
361-594-3629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 N. AVE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHINER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-594-2394
Provider Business Practice Location Address Fax Number:
361-594-3629
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILSCHER
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
361-594-2394

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  16094 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 16094 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 144135 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com