1609109479 NPI number — HOWARD THOMAS GANSER PHARMACIST

Table of content: HOWARD THOMAS GANSER PHARMACIST (NPI 1609109479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609109479 NPI number — HOWARD THOMAS GANSER PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANSER
Provider First Name:
HOWARD
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

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:
1609109479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 N WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99201-0233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-444-8888
Provider Business Mailing Address Fax Number:
509-444-7806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 W 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-835-1205
Provider Business Practice Location Address Fax Number:
509-835-7208
Provider Enumeration Date:
09/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH00046476 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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