1730431487 NPI number — XUBEX COMMUNITY PHARMACY INC

Table of content: (NPI 1730431487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730431487 NPI number — XUBEX COMMUNITY PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
XUBEX COMMUNITY 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:
XUBEX COMMUNITY 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:
1730431487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 S.R. 436
Provider Second Line Business Mailing Address:
SUITE 1010
Provider Business Mailing Address City Name:
CASSELBERRY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-624-5088
Provider Business Mailing Address Fax Number:
407-767-7770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 STATE ROAD 436 STE 1010
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASSELBERRY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32707-5376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-624-5088
Provider Business Practice Location Address Fax Number:
407-767-7770
Provider Enumeration Date:
10/04/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARIRI
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
908-331-2030

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH26529 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2137994 . This is a "PK" identifier . This identifiers is of the category "OTHER".