1508200163 NPI number — PHARMVUE CORPORATION

Table of content: (NPI 1508200163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508200163 NPI number — PHARMVUE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMVUE CORPORATION
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:
1508200163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1282 SMALLWOOD DR W
Provider Second Line Business Mailing Address:
SUITE 284
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20603-4732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-645-2400
Provider Business Mailing Address Fax Number:
301-476-0382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3460 OLD WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20602-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-645-2400
Provider Business Practice Location Address Fax Number:
301-476-0382
Provider Enumeration Date:
04/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
NAJWA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
301-645-2400

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  P05973 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 335728700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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