1518047950 NPI number — DISCOUNT DRUGS WISCONSIN, INC.

Table of content: (NPI 1518047950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518047950 NPI number — DISCOUNT DRUGS WISCONSIN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISCOUNT DRUGS WISCONSIN, 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:
RODMAN'S DISCOUNT FOOD & DRUGS
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:
1518047950
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:
4301 RANDOLPH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20906-4630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-230-8930
Provider Business Mailing Address Fax Number:
301-946-8329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 WISCONSIN AVE 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:
20016-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-363-3466
Provider Business Practice Location Address Fax Number:
202-363-5547
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHITALE
Authorized Official First Name:
ARVIN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
301-230-8930

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  RX8800103 , 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)





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