1770679672 NPI number — SHARMKEE INC

Table of content: (NPI 1770679672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770679672 NPI number — SHARMKEE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARMKEE 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:
EASTON DRUG COMPANY
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:
1770679672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARUTHERS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93609-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-237-0332
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5796 S ELM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93706-5813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-264-2965
Provider Business Practice Location Address Fax Number:
559-264-3160
Provider Enumeration Date:
10/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILCOX
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
559-696-6333

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY13360 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHA133600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0532603 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".