1679529291 NPI number — HAGGEN OPCO NORTH LLC

Table of content: (NPI 1679529291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679529291 NPI number — HAGGEN OPCO NORTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAGGEN OPCO NORTH 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:
HAGGEN PHARMACY #103
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:
1679529291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2211 RIMLAND DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98226-5664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-733-8720
Provider Business Mailing Address Fax Number:
360-752-6437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1128 N MILLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801-1541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-662-2942
Provider Business Practice Location Address Fax Number:
509-665-9170
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIPASQUA
Authorized Official First Name:
GAETANO
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE SENIOR VICE PRESIDEN
Authorized Official Telephone Number:
360-650-8204

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHAR.CF.60534402 , 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)

  • Identifier: 2150297 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com