1144368135 NPI number — CARE FIRST PHARMACY LLC

Table of content: (NPI 1144368135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144368135 NPI number — CARE FIRST PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE FIRST PHARMACY 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:
1144368135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 671759
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-1759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-552-7630
Provider Business Mailing Address Fax Number:
817-251-8139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5492 ADAMS AVE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON TERRACE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84405-4729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-479-4485
Provider Business Practice Location Address Fax Number:
801-479-4169
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LANHAM
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
817-328-6421

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  1704 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2122944 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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