1588123608 NPI number — DANVILLE HC, INC

Table of content: (NPI 1588123608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588123608 NPI number — DANVILLE HC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANVILLE HC, 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:
CONWAY'S DANVILLE 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:
1588123608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43014-0602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-481-2300
Provider Business Mailing Address Fax Number:
740-481-3019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-481-2300
Provider Business Practice Location Address Fax Number:
740-481-3019
Provider Enumeration Date:
03/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CONWAY
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
R.PH/OWNER
Authorized Official Telephone Number:
740-501-3831

Provider Taxonomy Codes

  • Taxonomy code: 183500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0363948 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0232000114 . This is a "OHIO STATE BOARD OF PHARMACY LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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