1932443520 NPI number — SAINT-MARK ENTERPRISES 1061 LLC

Table of content: (NPI 1932443520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932443520 NPI number — SAINT-MARK ENTERPRISES 1061 LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT-MARK ENTERPRISES 1061 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:
THE MEDICINE SHOPPE 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:
1932443520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 VIA SAINT LUCIA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89011-0873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-650-5541
Provider Business Mailing Address Fax Number:
702-568-8676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12414 E SPRAGUE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-0722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-924-1222
Provider Business Practice Location Address Fax Number:
509-922-6411
Provider Enumeration Date:
11/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ST GERMAIN
Authorized Official First Name:
RIK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-650-5514

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHAR.CF.60329557 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2139557 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com