1194127696 NPI number — CITY PHARMACY OF CHARLES TOWN, INC

Table of content: MRS. DAWN DENISE SINGLE CD (NPI 1093041147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194127696 NPI number — CITY PHARMACY OF CHARLES TOWN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY PHARMACY OF CHARLES TOWN, 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:
1194127696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
82 SOMERSET BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLES TOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25414-4827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-327-6140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 SOMERSET BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLES TOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25414-4827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-327-6140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WASANYI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MUSISI
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
540-327-6140

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com