1114926961 NPI number — PHARM PLUS ACQUISITION INC

Table of content: (NPI 1114926961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114926961 NPI number — PHARM PLUS ACQUISITION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARM PLUS ACQUISITION 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:
1114926961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5025 PLANO PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75010-5022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-365-8287
Provider Business Mailing Address Fax Number:
844-811-7689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 E HUNTER AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92807-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-801-1140
Provider Business Practice Location Address Fax Number:
469-365-8274
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPA
Authorized Official First Name:
SANDY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SR. CONSULTANT PAYER RELATIONS
Authorized Official Telephone Number:
909-799-4174

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X , with the licence number:  46321 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 46321 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHA463210 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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