1477921666 NPI number — PA HEALTHCARE PHARMACEUTICAL COMPANY

Table of content: (NPI 1477921666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477921666 NPI number — PA HEALTHCARE PHARMACEUTICAL COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PA HEALTHCARE PHARMACEUTICAL COMPANY
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:
1477921666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7183 NAVAJO RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92119-1696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-741-9117
Provider Business Mailing Address Fax Number:
888-502-2754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7183 NAVAJO RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92119-1696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-741-9117
Provider Business Practice Location Address Fax Number:
888-502-2754
Provider Enumeration Date:
09/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
DUANE
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
619-741-9117

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100057238 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026579700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103275591-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477921666 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2413601 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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