1568661338 NPI number — Z-INC

Table of content: (NPI 1568661338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568661338 NPI number — Z-INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Z-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:
PAULS 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:
1568661338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 937
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMEDALE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83628-0937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 E WYOMING
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMEDALE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-337-4888
Provider Business Practice Location Address Fax Number:
208-337-4898
Provider Enumeration Date:
07/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZATICA
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
208-337-3919

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  2168CP , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1307784 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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