1649508847 NPI number — DREW DURBIN, DO, PLLC

Table of content: MR. EDWARD FRANCIS REARDON PHARMACIST (NPI 1548478787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649508847 NPI number — DREW DURBIN, DO, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DREW DURBIN, DO, PLLC
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:
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:
1649508847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16601 N 40TH ST STE 119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85032-3355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-779-4999
Provider Business Mailing Address Fax Number:
480-779-4998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16601 N 40TH ST
Provider Second Line Business Practice Location Address:
SUITE #119-120
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85032-3345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-779-4999
Provider Business Practice Location Address Fax Number:
480-779-4998
Provider Enumeration Date:
11/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DURBIN
Authorized Official First Name:
DREW
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-779-4999

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4274 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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