1083920532 NPI number — DR. DARLINGTON FRIDAY EGBU PHARMACIST

Table of content: DR. DARLINGTON FRIDAY EGBU PHARMACIST (NPI 1083920532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083920532 NPI number — DR. DARLINGTON FRIDAY EGBU PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGBU
Provider First Name:
DARLINGTON
Provider Middle Name:
FRIDAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

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:
1083920532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWNPOINT
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87313-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-786-5563
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JUNCTION OF ROUTE 371 & ROUTE 9
Provider Second Line Business Practice Location Address:
CROWNPOINT HEALTHCARE FACILITY
Provider Business Practice Location Address City Name:
CROWNPOINT
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-786-6344
Provider Business Practice Location Address Fax Number:
505-786-2526
Provider Enumeration Date:
08/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  19097 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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