1851322937 NPI number — KINNEY DRUGS, INC. #88

Table of content: (NPI 1851322937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851322937 NPI number — KINNEY DRUGS, INC. #88

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINNEY DRUGS, INC. #88
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:
1851322937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 284
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARATHON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13803-0284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-849-6156
Provider Business Mailing Address Fax Number:
607-849-6111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARATHON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13803-0284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-849-6156
Provider Business Practice Location Address Fax Number:
607-849-6111
Provider Enumeration Date:
07/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
THIRD PARTY COORDINATOR
Authorized Official Telephone Number:
315-287-3600

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  027833 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02752409 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".