1235171893 NPI number — BUCKHEAD PHARMACEUTICAL ASSOCIATION INC

Table of content: (NPI 1235171893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235171893 NPI number — BUCKHEAD PHARMACEUTICAL ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUCKHEAD PHARMACEUTICAL ASSOCIATION 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:
BUCKHEAD PHARMACEUTICAL ASSOCIATION
Provider Other Organization Name Type Code:
3
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:
1235171893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 SOM CENTER RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
MAYFIELD VILLAGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44143-2350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-605-0303
Provider Business Mailing Address Fax Number:
440-605-1437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 SOM CENTER RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
MAYFIELD VILLAGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44143-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-605-0303
Provider Business Practice Location Address Fax Number:
440-605-1437
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRAGINSKY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
440-605-0303

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 021395150 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2079636 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2426520 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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