1629738760 NPI number — NEPHRON PHARMACY LLC

Table of content: (NPI 1629738760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629738760 NPI number — NEPHRON PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHRON PHARMACY LLC
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:
SUPERIOR POSTOP
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:
1629738760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3499 BLAZER PARKWAY
Provider Second Line Business Mailing Address:
SUITE G10 NORTH
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-327-3102
Provider Business Mailing Address Fax Number:
803-219-3858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3499 BLAZER PKWY STE G10 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-1850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-327-3102
Provider Business Practice Location Address Fax Number:
803-219-3858
Provider Enumeration Date:
12/29/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JIBAJA
Authorized Official First Name:
HANK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
407-579-4797

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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