1003464132 NPI number — LINTON SQUARE PHARMACY NORTH, 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 1003464132 NPI number — LINTON SQUARE PHARMACY NORTH, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINTON SQUARE PHARMACY NORTH, 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:
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:
1003464132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2580 METROCENTRE BLVD STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33407-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-302-0045
Provider Business Mailing Address Fax Number:
561-508-6938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2580 METROCENTRE BLVD STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-302-0045
Provider Business Practice Location Address Fax Number:
561-508-6938
Provider Enumeration Date:
09/02/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BARNHART
Authorized Official First Name:
TAWANA
Authorized Official Middle Name:
MICHELE
Authorized Official Title or Position:
REGISTERED AGENT
Authorized Official Telephone Number:
561-302-0045

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: PH32293 . This is a "FLORIDA DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com