1992747109 NPI number — NORTH EAST MEDICAL SERVICES

Table of content: (NPI 1992747109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992747109 NPI number — NORTH EAST MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH EAST MEDICAL SERVICES
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:
NORTH EAST MEDICAL SERVICES PHARMACY
Provider Other Organization Name Type Code:
5
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:
1992747109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 STOCKTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94133-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-391-9686
Provider Business Mailing Address Fax Number:
415-433-4726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 STOCKTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94133-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-391-9686
Provider Business Practice Location Address Fax Number:
415-391-9704
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAN
Authorized Official First Name:
EDDIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
415-391-9686

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY 40315 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1992747109 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PHY 40315 . This is a "STATE LIC: BD OF PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0592522 . This is a "NCPDP PREVIOUSLY NABP" identifier . This identifiers is of the category "OTHER".




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