1669466637 NPI number — CANTERS PHARMACY INC

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 1669466637 NPI number — CANTERS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANTERS 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:
1669466637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 GREENTREE RD
Provider Second Line Business Mailing Address:
A115
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15220-1452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-561-6532
Provider Business Mailing Address Fax Number:
412-561-6544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 GREENTREE RD
Provider Second Line Business Practice Location Address:
A115
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15220-1452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-561-6532
Provider Business Practice Location Address Fax Number:
412-561-6544
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WESTBROOK
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-561-6532

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000288967 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000571761 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3906116 . This is a "NABP" identifier . This identifiers is of the category "OTHER".




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