1366416448 NPI number — PACIFICO NATIONAL INC

Table of content: (NPI 1366416448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366416448 NPI number — PACIFICO NATIONAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFICO NATIONAL 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:
AMEX PHARMACY
Provider Other Organization Name Type Code:
3
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:
1366416448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 ELIZABETH ST
Provider Second Line Business Mailing Address:
STE J
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32901-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-872-0723
Provider Business Mailing Address Fax Number:
321-872-0721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 ELIZABETH ST
Provider Second Line Business Practice Location Address:
STE J
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-872-0723
Provider Business Practice Location Address Fax Number:
321-872-0721
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANGREE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
321-872-0723

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X , with the licence number:  16452MS , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 5301008923 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: PH27532 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: FL1446 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: NRX1701137 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: A9-0001042 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 3942 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: P03052 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 64000903A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 22-02899 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: PHNR 000556 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 006292 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 054.016601 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: PMP-1330 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1366416448 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1366416448 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 226807 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 546330 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000055714 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1366416448 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1366416448 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2856995 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02199910 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134038 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2013120 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201352590A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100410000 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026562600 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1028490 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105780400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200647710A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1366416448 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2059467 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500707688 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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