1760698542 NPI number — PROFESSIONAL PHARMACY ASSOCIATES

Table of content: (NPI 1760698542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760698542 NPI number — PROFESSIONAL PHARMACY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL PHARMACY ASSOCIATES
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:
Provider Other Organization Name Type Code:
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:
1760698542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 N WESTERN AVE STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUPACA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54981-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 N WESTERN AVE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUPACA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54981-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-245-2880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANGER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
715-256-2880

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  11837 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5127344 . This is a "NABP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com