1982776514 NPI number — MEDICAP PHARMACY OF CATAWBA,LLC

Table of content: ROBERTA SUE HAHN NP (NPI 1770936866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982776514 NPI number — MEDICAP PHARMACY OF CATAWBA,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAP PHARMACY OF CATAWBA,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:
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:
1982776514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 2ND AVE SW
Provider Second Line Business Mailing Address:
P.O. BOX 447
Provider Business Mailing Address City Name:
CATAWBA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28609-0447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-241-2422
Provider Business Mailing Address Fax Number:
828-241-9810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 2ND ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATAWBA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28609-8811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-241-2422
Provider Business Practice Location Address Fax Number:
828-241-9045
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOSER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MANAGING R.PH./ PARTNER
Authorized Official Telephone Number:
828-241-2422

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  4246 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0185629 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3421182 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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