1982619573 NPI number — CEDAR PHARMACY

Table of content: (NPI 1982619573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982619573 NPI number — CEDAR PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR PHARMACY
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982619573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8955 S PECOS RD STE 1B
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:
89074-7157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-436-0016
Provider Business Mailing Address Fax Number:
702-269-1654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8955 S PECOS RD STE 1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89074-7157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-436-0016
Provider Business Practice Location Address Fax Number:
702-269-1654
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHAU
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARM D, MANAGER PHARMACIST
Authorized Official Telephone Number:
702-436-0016

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH02068 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100507390 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4748900002 , issued by the state of ( NV ) . This identifiers is of the category "MEDICARE NSC".
  • Identifier: 2989272 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".