1740634138 NPI number — LIBBY MILLS NUTRITION

Table of content: (NPI 1740634138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740634138 NPI number — LIBBY MILLS NUTRITION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBBY MILLS NUTRITION
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:
1740634138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
437 W MINER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19382-2834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-546-1231
Provider Business Mailing Address Fax Number:
610-906-1330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 W WELSH POOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-546-1231
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLS
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-546-1231

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DN001410 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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