1306985635 NPI number — SWEETS DRUG STORE

Table of content: (NPI 1306985635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306985635 NPI number — SWEETS DRUG STORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWEETS DRUG STORE
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:
1306985635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
781 SEQUOIA AVE
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
LINDSAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93247-1447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-562-5991
Provider Business Mailing Address Fax Number:
559-562-9852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
781 SEQUOIA AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
LINDSAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93247-1447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-562-5991
Provider Business Practice Location Address Fax Number:
559-562-9852
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SWEET
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
559-562-5991

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY16872 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0526713 . This is a "NCPDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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