1619296761 NPI number — PARKWAY PHARMACY LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619296761 NPI number — PARKWAY PHARMACY LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKWAY PHARMACY LP
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:
1619296761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3502 US HIGHWAY 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07731-3345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-355-7797
Provider Business Mailing Address Fax Number:
888-551-6289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3502 US HIGHWAY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07731-3345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-355-7797
Provider Business Practice Location Address Fax Number:
888-551-6289
Provider Enumeration Date:
05/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BLEZNICK
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
866-355-7797

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  NRX0001118 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 28RS00706300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X , with the licence number: 12735 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 022-032200 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: NP000133 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 17174 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHN11258 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 36.018647 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PO6148 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 1053 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 4200 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 0214001769 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 5301010582 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PCN-0002571 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5240085 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0245691 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619296761 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2125729 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1026741160001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7N6300 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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