1053788638 NPI number — RPVR CORPORATION

Table of content: (NPI 1053788638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053788638 NPI number — RPVR CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RPVR CORPORATION
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:
FLEETWOOD PHARMACY
Provider Other Organization Name Type Code:
3
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:
1053788638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 KEMPSEY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29607-6431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-452-3165
Provider Business Mailing Address Fax Number:
864-442-5193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 FLEETWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASLEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29640-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-442-5192
Provider Business Practice Location Address Fax Number:
864-442-5193
Provider Enumeration Date:
08/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
BHAVESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
864-442-5192

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  16145 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2153893 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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