1972680486 NPI number — TEQUESTA DRUGS INC

Table of content: (NPI 1972680486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972680486 NPI number — TEQUESTA DRUGS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEQUESTA DRUGS 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:
1972680486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE MAIN ST
Provider Second Line Business Mailing Address:
#107
Provider Business Mailing Address City Name:
TEQUESTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-741-8222
Provider Business Mailing Address Fax Number:
561-741-8220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE MAIN ST
Provider Second Line Business Practice Location Address:
#107
Provider Business Practice Location Address City Name:
TEQUESTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-741-8222
Provider Business Practice Location Address Fax Number:
561-741-8220
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRUMER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PHARMACIST OWNER
Authorized Official Telephone Number:
561-741-8222

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PH21708 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 031679200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1016218 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com