Provider Demographics
NPI:1235436379
Name:E Z ACCESS PHARMACY INC
Entity Type:Organization
Organization Name:E Z ACCESS PHARMACY INC
Other - Org Name:E Z ACCESS PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-223-2383
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:MARSHALLS CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18335-0301
Mailing Address - Country:US
Mailing Address - Phone:570-223-2383
Mailing Address - Fax:877-856-4692
Practice Address - Street 1:107 KIOWA LN
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6751
Practice Address - Country:US
Practice Address - Phone:864-272-2806
Practice Address - Fax:877-856-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC114413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4230190OtherNCPDP PROVIDER IDENTIFICATION NUMBER