1760532394 NPI number — DEPT. OF PUBLIC HEALTH PHARMACY-NRCHC

Table of content: (NPI 1760532394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760532394 NPI number — DEPT. OF PUBLIC HEALTH PHARMACY-NRCHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPT. OF PUBLIC HEALTH PHARMACY-NRCHC
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:
1760532394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2816
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAGATNA
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96932-2816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-635-7492
Provider Business Mailing Address Fax Number:
671-635-7493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 W SANTA MONICA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDEDO
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96929-5286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-635-7492
Provider Business Practice Location Address Fax Number:
671-635-7493
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DENORCEY
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
UNPINGCO
Authorized Official Title or Position:
HEALTH SERVICES ADMINISTRATOR
Authorized Official Telephone Number:
671-635-7492

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X , with the licence number:  11-P020 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 654 , issued by the state of ( GU ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5412426 . This is a "NCPDP NUMBER" identifier , issued by the state of ( GU ) . This identifiers is of the category "OTHER".




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