1780621169 NPI number — DIXWELL PHARMACY LLC

Table of content: (NPI 1780621169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780621169 NPI number — DIXWELL PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIXWELL PHARMACY 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:
APEX PHARMACY & HOME CARE CENTER
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:
1780621169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2380 DIXWELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06514-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-281-6571
Provider Business Mailing Address Fax Number:
203-281-3132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2380 DIXWELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06514-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-281-6571
Provider Business Practice Location Address Fax Number:
203-281-3132
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARUPALLI
Authorized Official First Name:
NAVEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
203-281-6571

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PCY.0000382 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2149107 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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