1619195898 NPI number — WAKEFIELD PHARMACY INC.

Table of content: (NPI 1619195898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619195898 NPI number — WAKEFIELD PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAKEFIELD 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:
1619195898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13525 LEFFERTS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH OZONE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11420-3601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-843-3900
Provider Business Mailing Address Fax Number:
718-843-6044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13525 LEFFERTS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH OZONE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11420-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-843-3900
Provider Business Practice Location Address Fax Number:
718-843-6044
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
718-843-3900

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  30920 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3375816 . This is a "NAPB NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 017693 . This is a "STORE STATE LICENSE NO." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com