1265049647 NPI number — WEST NORTH PHARMACY, INC

Table of content: (NPI 1265049647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265049647 NPI number — WEST NORTH PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST NORTH 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:
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:
1265049647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3044 W NORTH AVE STE A&B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21216-3180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-873-6184
Provider Business Mailing Address Fax Number:
443-885-9952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3044 W NORTH AVE STE A&B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21216-3180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-873-6184
Provider Business Practice Location Address Fax Number:
443-885-9952
Provider Enumeration Date:
09/29/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ADEOLA
Authorized Official First Name:
OMOLARA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
443-677-7130

Provider Taxonomy Codes

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

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

  • Identifier: 63140256 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com