1093872780 NPI number — NORTHWEST PHARMACY GROUP LLC.

Table of content: (NPI 1093872780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093872780 NPI number — NORTHWEST PHARMACY GROUP LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST PHARMACY GROUP 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:
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:
1093872780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 URB.ALTAMIRA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARES
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-636-1512
Provider Business Mailing Address Fax Number:
787-891-8614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 110 KM 22.9 BARRIO CEIBA BAJA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-882-2000
Provider Business Practice Location Address Fax Number:
787-891-8614
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARCHESE
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-636-1512

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: 038243000 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4018708 . This is a "NCPDP OR NABP NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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