1568504496 NPI number — ACHI PHARM, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568504496 NPI number — ACHI PHARM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACHI PHARM, 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:
MEDICINE SHOPPE 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:
1568504496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 RUBY LAKE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33884-3269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-224-7234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 HAVENDALE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURNDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33823-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-967-3632
Provider Business Practice Location Address Fax Number:
863-967-8469
Provider Enumeration Date:
02/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ABUH
Authorized Official First Name:
YAHAYA
Authorized Official Middle Name:
FIDELIS
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
863-224-7234

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH22593 , 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: 1026815 . This is a "NCPDP #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".