1255396396 NPI number — ALBION PHARMACY INC

Table of content: (NPI 1255396396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255396396 NPI number — ALBION PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBION PHARMACY 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:
1255396396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMLENTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16373-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-756-3429
Provider Business Mailing Address Fax Number:
814-756-5882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 EAST STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16401-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-756-3429
Provider Business Practice Location Address Fax Number:
814-756-5882
Provider Enumeration Date:
04/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DREHER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-756-3429

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PP410032L . This is a "PHARMACY LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005677400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3913565 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".