1184997280 NPI number — GOOD SHEPHERD PHARMACY INC

Table of content: (NPI 1184997280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184997280 NPI number — GOOD SHEPHERD PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SHEPHERD PHARMACY 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:
1184997280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1505
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SABANA GRANDE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00637-3505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-978-7300
Provider Business Mailing Address Fax Number:
787-978-7301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 368 KM 0.8 PLAZA ISABELLA
Provider Second Line Business Practice Location Address:
BO. MACHUCHAL
Provider Business Practice Location Address City Name:
SABANA GRANDE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-978-7300
Provider Business Practice Location Address Fax Number:
787-978-7302
Provider Enumeration Date:
02/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FIGUEROA
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-888-8099

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  16F3031 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2134654 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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