1235379298 NPI number — FCRX INC

Table of content: (NPI 1235379298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235379298 NPI number — FCRX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FCRX 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:
1235379298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9740B UNIVERSITY CITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28213-3608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-688-5330
Provider Business Mailing Address Fax Number:
704-510-4311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4922 ALBEMARLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-909-5610
Provider Business Practice Location Address Fax Number:
704-909-5611
Provider Enumeration Date:
03/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
SANJAY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-451-5051

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; 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: "Y" .

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

  • Identifier: 0602410 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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