1144654930 NPI number — PHARMCARE USA OF EDISON, INC.

Table of content: (NPI 1144654930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144654930 NPI number — PHARMCARE USA OF EDISON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMCARE USA OF EDISON, 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:
1144654930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYDRO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73048-0012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-663-4111
Provider Business Mailing Address Fax Number:
405-663-4114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 NEWFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE A AND B
Provider Business Practice Location Address City Name:
EDISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08837-3824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-733-2354
Provider Business Practice Location Address Fax Number:
732-346-1999
Provider Enumeration Date:
08/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ABBOTT
Authorized Official First Name:
KENT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-663-4111

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  028765 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 28RS00675800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2141733 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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