1780676510 NPI number — MEMORIAL PILL BOX

Table of content: (NPI 1780676510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780676510 NPI number — MEMORIAL PILL BOX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL PILL BOX
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:
CAPSULE 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:
1780676510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 W 146TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10039-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-685-9515
Provider Business Mailing Address Fax Number:
646-934-6409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
168 NW 26TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33127-4422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-515-9000
Provider Business Practice Location Address Fax Number:
954-368-6833
Provider Enumeration Date:
08/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KINARIWALA
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
888-685-9515

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PH11940 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PH11940 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101616400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109438200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".