1992851273 NPI number — SAYER-MCKEE DRUG STORE

Table of content: (NPI 1992851273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992851273 NPI number — SAYER-MCKEE DRUG STORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAYER-MCKEE DRUG STORE
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:
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:
1992851273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 HARRISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEADVILLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80461-3559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-486-1846
Provider Business Mailing Address Fax Number:
719-486-0624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 HARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEADVILLE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80461-3559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-486-1846
Provider Business Practice Location Address Fax Number:
719-486-0624
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LONGWELL
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
719-486-1846

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  770000001 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 86325710 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com