1851485148 NPI number — CHIEF SUPER MARKET INC

Table of content: (NPI 1851485148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851485148 NPI number — CHIEF SUPER MARKET INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIEF SUPER MARKET 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:
CHIEF PHARMACY AND WELLNESS CENTER
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:
1851485148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1340 W HIGH ST
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
DEFIANCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43512-5302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-784-0088
Provider Business Mailing Address Fax Number:
419-784-2273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 DEATRICK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEFIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43512-2785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-784-0088
Provider Business Practice Location Address Fax Number:
419-784-2273
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STAFFORD
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE SECRETARY
Authorized Official Telephone Number:
419-782-0950

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: 021695800 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3668641 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2737480 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com