1871881573 NPI number — ETHICAL FACTOR RX LLC

Table of content: (NPI 1871881573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871881573 NPI number — ETHICAL FACTOR RX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ETHICAL FACTOR RX 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:
ETHICAL FACTOR RX
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:
1871881573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18505-6047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-606-3622
Provider Business Mailing Address Fax Number:
570-371-6317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4213 BIRNEY AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MOOSIC
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-606-3622
Provider Business Practice Location Address Fax Number:
570-371-6317
Provider Enumeration Date:
07/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TOMCYKOSKI
Authorized Official First Name:
LISA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-606-3622

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5301009850 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 28RO00071900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P06270 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PP482191 , registered in the state of PA ; 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: "Y" .

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

  • Identifier: 102678278 0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871881573 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871881573 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871881573 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0298883 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03629343 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200595730A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2131101 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1871881573 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871881573 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4222598 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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