1508852120 NPI number — CHOICE CRITICAL CARE RX LLC

Table of content: (NPI 1508852120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508852120 NPI number — CHOICE CRITICAL CARE RX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICE CRITICAL CARE RX 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:
CHOICE CRITICAL CARE LTC PHARMACY
Provider Other Organization Name Type Code:
3
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:
1508852120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 NORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BERLIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17316-7831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-630-2773
Provider Business Mailing Address Fax Number:
717-630-2824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 NORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17316-7831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-630-2773
Provider Business Practice Location Address Fax Number:
717-630-2824
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MINNICH
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
717-630-2773

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PP414600L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PP414600L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1037377490001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7812580001 . This is a "NSC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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