1992788020 NPI number — JA MCNEILL & SONS & DAUGHTER LLC

Table of content: MAI CHANG CADTP 14670 (NPI 1255039665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992788020 NPI number — JA MCNEILL & SONS & DAUGHTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JA MCNEILL & SONS & DAUGHTER 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:
MCNEILLS LONG TERM CARE PHARMACY
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:
1992788020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28472-7189
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:
712 TRAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28472-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-642-0388
Provider Business Practice Location Address Fax Number:
866-642-1152
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCNEILL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-815-3122

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  07711 , 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: 0245794 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2072309 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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