1780126508 NPI number — CONCEPTION PHARMACY LLC

Table of content: (NPI 1780126508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780126508 NPI number — CONCEPTION PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCEPTION PHARMACY 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:
ALTO PHARMACY
Provider Other Organization Name Type Code:
3
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:
1780126508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4950 TERMINAL ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77401-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-874-5881
Provider Business Mailing Address Fax Number:
415-484-7780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4950 TERMINAL ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLAIRE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77401-6013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-602-1990
Provider Business Practice Location Address Fax Number:
415-484-7058
Provider Enumeration Date:
11/10/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAMMOND
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTING
Authorized Official Telephone Number:
800-874-5881

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 31079 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 31079 . This is a "PHARMACY PERMIT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1780126508 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2166128 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5920120 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".