1841327681 NPI number — MEDICAL CENTER PHARMACY INC OF QUINCY

Table of content: (NPI 1841327681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841327681 NPI number — MEDICAL CENTER PHARMACY INC OF QUINCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL CENTER PHARMACY INC OF QUINCY
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:
MEDICAL CENTER 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:
1841327681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 E JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32351-2530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-627-7595
Provider Business Mailing Address Fax Number:
850-875-1977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32351-2530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-627-7595
Provider Business Practice Location Address Fax Number:
850-875-1977
Provider Enumeration Date:
02/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAINEY MASSEY
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-627-7595

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: PH8793 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1019961 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100314300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1019961 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".