1609845502 NPI number — LINTON SQUARE PHARMACY & MEDICAL SUPPLIES INC

Table of content: (NPI 1609845502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609845502 NPI number — LINTON SQUARE PHARMACY & MEDICAL SUPPLIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINTON SQUARE PHARMACY & MEDICAL SUPPLIES 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:
LINTON SQUARE 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:
1609845502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 S CONGRESS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33445-6368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-272-0015
Provider Business Mailing Address Fax Number:
561-272-3059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 S CONGRESS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33445-6368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-272-0015
Provider Business Practice Location Address Fax Number:
561-272-3059
Provider Enumeration Date:
03/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEN-AMOZ
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
BENEFICIAL OWNER
Authorized Official Telephone Number:
561-272-0015

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH24229 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 106586600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106586601 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2012143 . This is a "PK" identifier . This identifiers is of the category "OTHER".