1417246299 NPI number — GOODWILL PHARMACY INC

Table of content: (NPI 1417246299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417246299 NPI number — GOODWILL PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOODWILL PHARMACY 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:
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:
1417246299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2602 WILMINGTON RD
Provider Second Line Business Mailing Address:
# 100
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16105-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-202-6297
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2602 WILMINGTON RD
Provider Second Line Business Practice Location Address:
# 100
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16105-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-202-6297
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NARAYANAKUMAR
Authorized Official First Name:
RAMPRAKASH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
724-202-6297

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PP482104 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3995240 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".