1336244110 NPI number — COMPREHENSIVE PHARMACY SERVICES LLC

Table of content: (NPI 1336244110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336244110 NPI number — COMPREHENSIVE PHARMACY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE PHARMACY SERVICES LLC
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:
1336244110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 METRO PL S STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017-3388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-748-0470
Provider Business Mailing Address Fax Number:
614-766-0101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 GARNET WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARM SPRINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-693-7178
Provider Business Practice Location Address Fax Number:
406-693-7181
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCARRELL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
740-816-2499

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  970 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 1342 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 214591 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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