1699820589 NPI number — HORSNYDER PHARMACY INC

Table of content: (NPI 1699820589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699820589 NPI number — HORSNYDER PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORSNYDER PHARMACY 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:
HORSNYDER 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:
1699820589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1226 SOQUEL AVE STE A
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95062-2157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-423-2315
Provider Business Mailing Address Fax Number:
831-423-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1226 SOQUEL AVE STE A
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95062-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-423-2315
Provider Business Practice Location Address Fax Number:
831-423-2320
Provider Enumeration Date:
01/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
QUESENBERRY
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
831-423-2315

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY51860 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: PHA51860 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2146447 . This is a "PK" identifier . This identifiers is of the category "OTHER".