1851763924 NPI number — BOBROWSKI INDUSTRIES PRINCETON LLC

Table of content: (NPI 1851763924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851763924 NPI number — BOBROWSKI INDUSTRIES PRINCETON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOBROWSKI INDUSTRIES PRINCETON 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:
FAWCETTS 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:
1851763924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOONEVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41314-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-599-5515
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61356-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-872-3251
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BOBROWSKI
Authorized Official First Name:
NELSON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-599-5515

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  054014751 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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