1689163925 NPI number — PHARMAPRODIA LLC

Table of content: (NPI 1932266475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689163925 NPI number — PHARMAPRODIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMAPRODIA 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:
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:
1689163925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15331 W BELL RD
Provider Second Line Business Mailing Address:
SUITE 122
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85374-4102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-404-1000
Provider Business Mailing Address Fax Number:
623-256-6491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15331 W BELL RD STE 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85374-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-404-1000
Provider Business Practice Location Address Fax Number:
623-256-6491
Provider Enumeration Date:
05/02/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NKWENTI
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
623-432-5500

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: Y007343 , 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)

  • Identifier: 2177335 . This is a "PK" identifier . This identifiers is of the category "OTHER".