1407922164 NPI number — NELLS INC

Table of content: (NPI 1407922164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407922164 NPI number — NELLS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NELLS 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:
1407922164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1424 BALTIMORE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17331-8529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1424 BALTIMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17331-8529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-637-1075
Provider Business Practice Location Address Fax Number:
717-637-3625
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRANGER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY SUPERVISOR
Authorized Official Telephone Number:
610-678-8867

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP415171L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007781580010 . This is a "MEDICAID 2" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01587407 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3971719 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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