1952622037 NPI number — PROGRESSIVE PHARMACY & MEDICAL SUPPLY INC

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 1952622037 NPI number — PROGRESSIVE PHARMACY & MEDICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE PHARMACY & MEDICAL SUPPLY 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:
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:
1952622037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10322 CORONA AVE
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11368-3178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-271-7486
Provider Business Mailing Address Fax Number:
718-271-7487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10322 CORONA AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11368-3178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-271-7486
Provider Business Practice Location Address Fax Number:
718-271-7487
Provider Enumeration Date:
06/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ADJEPONG
Authorized Official First Name:
AUGUSTINES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/ PHARMACIST
Authorized Official Telephone Number:
718-271-7486

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  030190 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5800695 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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