1497341838 NPI number — PAMELA JEAN MAYFIELD DOCTOR OF PHARMACY

Table of content: PAMELA JEAN MAYFIELD DOCTOR OF PHARMACY (NPI 1497341838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497341838 NPI number — PAMELA JEAN MAYFIELD DOCTOR OF PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYFIELD
Provider First Name:
PAMELA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DOCTOR OF PHARMACY
Provider Gender Code:
F

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:
1497341838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 ISLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08343-1864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-889-0223
Provider Business Mailing Address Fax Number:
856-582-3962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
382 EGG HARBOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08080-1857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-582-3961
Provider Business Practice Location Address Fax Number:
856-582-3962
Provider Enumeration Date:
12/20/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  28RJ04465 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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