1568551240 NPI number — GWYNOAK PHARMACY INC

Table of content: (NPI 1568551240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568551240 NPI number — GWYNOAK PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GWYNOAK PHARMACY INC
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:
1568551240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1808 WOODLAWN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GWYNN OAK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21207-4023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1808 WOODLAWN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GWYNN OAK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21207-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-944-6911
Provider Business Practice Location Address Fax Number:
410-944-6988
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FAKUNLE
Authorized Official First Name:
SHERIFAT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHARM
Authorized Official Telephone Number:
410-944-6911

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  P04385 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 2132671 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com