1427109206 NPI number — CONKLING'S PHARMACY

Table of content: (NPI 1427109206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427109206 NPI number — CONKLING'S PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONKLING'S PHARMACY
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:
GREG'S LONG TERM CARE 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:
1427109206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANDORA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45877-0296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-384-3303
Provider Business Mailing Address Fax Number:
419-384-3308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANDORA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-384-3303
Provider Business Practice Location Address Fax Number:
419-384-3308
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONKLING
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
419-384-3303

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  02-0851200 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3673743 . This is a "NABP NCPDP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02-0851200 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com