1821057316 NPI number — PHARMACY ASSOCIATES, INC

Table of content: (NPI 1902528508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821057316 NPI number — PHARMACY ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACY ASSOCIATES, INC
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:
1821057316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1308 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-525-1222
Provider Business Mailing Address Fax Number:
304-525-6591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1308 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-1222
Provider Business Practice Location Address Fax Number:
304-525-6591
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
BRANDY
Authorized Official Middle Name:
GRACE
Authorized Official Title or Position:
VP,PHARMACY
Authorized Official Telephone Number:
941-877-0703

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: SPO550060 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5138507 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0670939 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200088730A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3119970 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01912050 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0553982 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100246280B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 777902000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8509620 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0144228000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5010094 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7W0060 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806956000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 969777 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0230163 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5010094 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54022454 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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