1457393993 NPI number — FCS PHARMACY LLC

Table of content: (NPI 1457393993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457393993 NPI number — FCS PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FCS PHARMACY LLC
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:
1457393993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 533211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28290-3211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-223-7151
Provider Business Mailing Address Fax Number:
561-995-9162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 BROKEN SOUND PKWY
Provider Second Line Business Practice Location Address:
SUITE 252
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33487-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-223-7151
Provider Business Practice Location Address Fax Number:
561-995-9162
Provider Enumeration Date:
06/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOSTWICK
Authorized Official First Name:
JARRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-314-1700

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH18941 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 025907100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200410770A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".