1619296761 NPI number — PARKWAY PHARMACY LP

Table of content: (NPI 1619296761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619296761 NPI number — PARKWAY PHARMACY LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKWAY PHARMACY LP
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:
PARKWAY PHARMACY LP
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:
1619296761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3502 US HIGHWAY 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07731-3345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-355-7797
Provider Business Mailing Address Fax Number:
888-551-6289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3502 US HIGHWAY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07731-3345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-355-7797
Provider Business Practice Location Address Fax Number:
888-551-6289
Provider Enumeration Date:
05/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BLEZNICK
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
866-355-7797

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  NRX0001118 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 28RS00706300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X , with the licence number: 12735 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 022-032200 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: NP000133 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 17174 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHN11258 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 36.018647 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PO6148 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 1053 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 4200 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 0214001769 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 5301010582 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PCN-0002571 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5240085 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0245691 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619296761 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2125729 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1026741160001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7N6300 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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