1003924234 NPI number — NEWTOWN SQUARE PHARMACY INC

Table of content: (NPI 1003924234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003924234 NPI number — NEWTOWN SQUARE PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWTOWN SQUARE PHARMACY INC
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:
6
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:
1003924234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98-1247 KAAHUMANU ST
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
AIEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96701-5311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-488-5458
Provider Business Mailing Address Fax Number:
808-484-9229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98-1247 KAAHUMANU ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-488-5458
Provider Business Practice Location Address Fax Number:
808-484-9229
Provider Enumeration Date:
08/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IKEHARA
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
808-488-5458

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY518 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03074401 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2018741 . This is a "PK" identifier . This identifiers is of the category "OTHER".