1184738403 NPI number — PRICE CHOPPER OPERATING CO INC

Table of content: (NPI 1184738403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184738403 NPI number — PRICE CHOPPER OPERATING CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRICE CHOPPER OPERATING CO 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:
1184738403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
461 NOTT ST
Provider Second Line Business Mailing Address:
MB#202
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12308-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-379-1618
Provider Business Mailing Address Fax Number:
518-356-6978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3761 MAIN ST
Provider Second Line Business Practice Location Address:
US RTE 9
Provider Business Practice Location Address City Name:
WARRENSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12885-1837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-623-2993
Provider Business Practice Location Address Fax Number:
518-623-3169
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRYANT
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PHARMACY
Authorized Official Telephone Number:
518-379-1122

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  26540 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2523146 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2061440 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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