1346375359 NPI number — BERINGER DRUG STORE INC

Table of content: (NPI 1346375359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346375359 NPI number — BERINGER DRUG STORE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERINGER DRUG STORE 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:
1346375359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESCENT CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32112-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-567-4678
Provider Business Mailing Address Fax Number:
859-567-4674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 WEST MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-567-4678
Provider Business Practice Location Address Fax Number:
859-567-4674
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
PATTY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
386-698-3737

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  P06107 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: PO6107 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9002039700 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000069795 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 133453741 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2047056 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22885 . This is a "ABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4582049 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5403319600 . This is a "KYHEALTH CHOICES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com