1235248188 NPI number — INSTITUTIONAL PHARMACY SOLUTIONS LLC

Table of content: (NPI 1235248188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235248188 NPI number — INSTITUTIONAL PHARMACY SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTIONAL PHARMACY SOLUTIONS 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:
INSTITUTIONAL PHARMACY SOLUTIONS
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:
1235248188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3480 EASTERN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36116-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-819-4500
Provider Business Mailing Address Fax Number:
334-819-4520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 SCENIC HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GADSDEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35904-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-794-7373
Provider Business Practice Location Address Fax Number:
334-356-7647
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIMS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
334-356-7627

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  180154 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100010021 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1995414 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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