1881866408 NPI number — MARVA HEALTH SERVICES LLC

Table of content: (NPI 1881866408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881866408 NPI number — MARVA HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARVA HEALTH SERVICES 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:
POCOMOKE DISCOUNT 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:
1881866408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 10TH ST
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
POCOMOKE CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21851-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-957-9030
Provider Business Mailing Address Fax Number:
410-957-9033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 10TH ST
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
POCOMOKE CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21851-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-957-9030
Provider Business Practice Location Address Fax Number:
410-957-9033
Provider Enumeration Date:
03/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
ZAHEER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-430-5530

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P04742 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2038351 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 414749900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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