1447728373 NPI number — GOODWILL PHARMACY INC.

Table of content: (NPI 1447728373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447728373 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:
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:
1447728373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2610 S. JONES BLVD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89146-5663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-213-3102
Provider Business Mailing Address Fax Number:
702-940-7580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2610 S. JONES BLVD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-5663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-213-3102
Provider Business Practice Location Address Fax Number:
702-940-7580
Provider Enumeration Date:
11/08/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PASRICHA
Authorized Official First Name:
ARUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-213-3102

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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