1043225675 NPI number — LORETTO DRUGS L L C

Table of content: (NPI 1043225675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043225675 NPI number — LORETTO DRUGS L L C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORETTO DRUGS L L C
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:
LORETTO DRUGS LLC
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:
1043225675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LORETTO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38469-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORETTO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38469-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-853-5910
Provider Business Practice Location Address Fax Number:
931-853-5930
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WAYNE
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
931-853-5920

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 3933 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2093982 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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