1407248503 NPI number — RAINA PHARMACY LLC

Table of content: (NPI 1407248503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407248503 NPI number — RAINA PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAINA PHARMACY 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:
RED JACKET PHARMACY, MEDICINE SHOPPE 2025
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:
1407248503
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:
PO BOX 86
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14504-0086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-289-3002
Provider Business Mailing Address Fax Number:
585-289-8707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14504-9786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-289-3002
Provider Business Practice Location Address Fax Number:
585-289-8707
Provider Enumeration Date:
02/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
ABHISHEK
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
585-289-3002

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 033397 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2150641 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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