1982709309 NPI number — MEDEXPRESS PHARMACY, LTD.

Table of content: (NPI 1982709309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982709309 NPI number — MEDEXPRESS PHARMACY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDEXPRESS PHARMACY, LTD.
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:
1982709309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1431 W. INNES STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-633-3977
Provider Business Mailing Address Fax Number:
800-615-0075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 W. INNES STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-633-3977
Provider Business Practice Location Address Fax Number:
800-615-0075
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEPORTER
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PHARM. OPS
Authorized Official Telephone Number:
225-236-1549

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  07849 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 12033 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3439278 . This is a "NCPDP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0805739 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010071267 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982709309 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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