Provider Demographics
NPI:1760555395
Name:GNN CORPORATION
Entity Type:Organization
Organization Name:GNN CORPORATION
Other - Org Name:HARMON DRUGS STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-ON-DUTY
Authorized Official - Prefix:
Authorized Official - First Name:ADELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:671-637-1473
Mailing Address - Street 1:PO BOX 8682
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-8682
Mailing Address - Country:US
Mailing Address - Phone:671-637-1473
Mailing Address - Fax:671-637-1475
Practice Address - Street 1:2226 ARMY DR
Practice Address - Street 2:STE A
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6577
Practice Address - Country:US
Practice Address - Phone:671-637-1473
Practice Address - Fax:671-637-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GUPCY0083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5410484OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GU634Medicaid