1598159493 NPI number — SAINT GEORGE & SAINT MOSES LLC

Table of content: (NPI 1598159493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598159493 NPI number — SAINT GEORGE & SAINT MOSES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT GEORGE & SAINT MOSES 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:
THE DRUGSTORE
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:
1598159493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 CR 4114 SUITE 1
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
PITTSBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-708-7500
Provider Business Mailing Address Fax Number:
903-708-7508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 COUNTY ROAD 4114
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-708-7500
Provider Business Practice Location Address Fax Number:
903-708-7508
Provider Enumeration Date:
03/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GHALI
Authorized Official First Name:
ALFONSE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
903-708-7500

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  29889 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 29889 . This is a "TSBP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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