1932658614 NPI number — DIABETIC APOTHECARY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932658614 NPI number — DIABETIC APOTHECARY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABETIC APOTHECARY 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:
Provider Other Organization Name Type Code:
6
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:
1932658614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6191 ORANGE DR
Provider Second Line Business Mailing Address:
#6177 N
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33314-3449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-775-5370
Provider Business Mailing Address Fax Number:
602-775-5371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15640 N 28TH DR
Provider Second Line Business Practice Location Address:
SUITE PHARMACY
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85053-4059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-775-5370
Provider Business Practice Location Address Fax Number:
602-775-5371
Provider Enumeration Date:
09/23/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SINGH
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERTIONS MANAGER/AO
Authorized Official Telephone Number:
954-371-6122

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: Y006969 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2164274 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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