1194236307 NPI number — EMPLOYEES PHARMACY LLC

Table of content: (NPI 1194236307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194236307 NPI number — EMPLOYEES PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPLOYEES 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:
VOLVO FAMILY HEALTH CENTER
Provider Other Organization Name Type Code:
5
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:
1194236307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 N PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68025-4964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-753-2800
Provider Business Mailing Address Fax Number:
866-441-1680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4881 COUGAR TRAIL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24084-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-674-4181
Provider Business Practice Location Address Fax Number:
540-674-7391
Provider Enumeration Date:
10/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
THIESSEN
Authorized Official First Name:
RONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSING COORDINATOR
Authorized Official Telephone Number:
402-753-2800

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0201004820 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2172235 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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