1720398407 NPI number — AMERICAN TLC FOUNDATION CENTER INC

Table of content: (NPI 1720398407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720398407 NPI number — AMERICAN TLC FOUNDATION CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN TLC FOUNDATION CENTER 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:
TLC PHARMACY DISCOUNT
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:
1720398407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19112 NW 23 COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-635-0397
Provider Business Mailing Address Fax Number:
305-888-2070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 WEST 12 AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-635-0397
Provider Business Practice Location Address Fax Number:
305-888-2070
Provider Enumeration Date:
10/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JEANNINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-635-0397

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com