1891871802 NPI number — MR. BRIAN WILLIAM HUCKLE

Table of content: MR. BRIAN WILLIAM HUCKLE (NPI 1891871802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891871802 NPI number — MR. BRIAN WILLIAM HUCKLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUCKLE
Provider First Name:
BRIAN
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1891871802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5632 E CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH WALES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14139-9763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-655-2001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 SMITH STREET
Provider Second Line Business Practice Location Address:
PHARMACY FIRST , SUITE 502
Provider Business Practice Location Address City Name:
NANUET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-623-8599
Provider Business Practice Location Address Fax Number:
845-623-5956
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  28699 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 28699 . This is a "PHARMACY STATE LICENSE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com