1275513707 NPI number — HEALTH PROFESSIONAL RESOURCES INC

Table of content: (NPI 1275513707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275513707 NPI number — HEALTH PROFESSIONAL RESOURCES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH PROFESSIONAL RESOURCES 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:
1275513707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 MICHIGAN AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
LOGANSPORT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46947-1580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-732-0418
Provider Business Mailing Address Fax Number:
574-753-8549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-1580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-732-0418
Provider Business Practice Location Address Fax Number:
574-753-8549
Provider Enumeration Date:
01/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOWEN
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
574-732-0418

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 60004263B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100294260A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2027371 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com