1912473695 NPI number — HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC.

Table of content: MR. CHESTER DAVON ROSS MS (NPI 1952992851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912473695 NPI number — HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHDIRECT INSTITUTIONAL PHARMACY SERVICES, INC.
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912473695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOUVERNEUR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13642-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-287-3600
Provider Business Mailing Address Fax Number:
315-287-4291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 W MAIN ST STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-1533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-547-1989
Provider Business Practice Location Address Fax Number:
724-542-4148
Provider Enumeration Date:
10/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BARBER
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
V
Authorized Official Title or Position:
DIRECTOR OF PBM RELATIONS
Authorized Official Telephone Number:
315-287-3600

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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