1679116453 NPI number — CBTP PARTNERS LLC

Table of content: (NPI 1679116453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679116453 NPI number — CBTP PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CBTP PARTNERS LLC
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:
1679116453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10195 HIGHWAY 221 STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODRUFF
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29388-9358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-670-8150
Provider Business Mailing Address Fax Number:
864-670-8151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10195 HIGHWAY 221 STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODRUFF
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29388-9358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-670-8150
Provider Business Practice Location Address Fax Number:
864-670-8151
Provider Enumeration Date:
10/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BAUMGARDNER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CO-OWNER/PHARMACIST
Authorized Official Telephone Number:
864-316-9689

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19165 . This is a "SC PHARMACY PERMIT NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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