1033420484 NPI number — ZIKS FAMILY PHARMACY INC 100

Table of content: MRS. HEIDI ELAINE WIGHT OTRL (NPI 1447462650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033420484 NPI number — ZIKS FAMILY PHARMACY INC 100

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZIKS FAMILY PHARMACY INC 100
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:
1033420484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 W 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45402-6812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-225-9350
Provider Business Mailing Address Fax Number:
937-225-9355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45402-6812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-225-9350
Provider Business Practice Location Address Fax Number:
937-225-9355
Provider Enumeration Date:
06/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
IHEME
Authorized Official First Name:
NNODUM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-225-9350

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: 022055300 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3679101 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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