1437505880 NPI number — PHYSICIANS EAST PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437505880 NPI number — PHYSICIANS EAST PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS EAST PA
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:
1437505880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3488 DEPT #05-800
Provider Second Line Business Mailing Address:
C/O PHARMAPOINT
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-795-8800
Provider Business Mailing Address Fax Number:
205-795-8880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 W ARLINGTON BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-5704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-413-6208
Provider Business Practice Location Address Fax Number:
252-413-6211
Provider Enumeration Date:
05/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LANCASTER
Authorized Official First Name:
BLAKE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
205-795-8800

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: 12946 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2159700 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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