1972865921 NPI number — KASHIBEN SAY 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 1972865921 NPI number — KASHIBEN SAY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KASHIBEN SAY 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:
DUNNELLON DISCOUNT DRUGS
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:
1972865921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11150 N WILLIAMS ST
Provider Second Line Business Mailing Address:
UNIT 101-B
Provider Business Mailing Address City Name:
DUNNELLON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34432-8363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-489-4960
Provider Business Mailing Address Fax Number:
352-489-4962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11150 N WILLIAMS ST
Provider Second Line Business Practice Location Address:
UNIT 101-B
Provider Business Practice Location Address City Name:
DUNNELLON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34432-8363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-489-4960
Provider Business Practice Location Address Fax Number:
352-489-4962
Provider Enumeration Date:
06/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VORA
Authorized Official First Name:
TAPAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
352-489-4960

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007631400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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