1114951845 NPI number — GERMANTOWN PHARMA INC

Table of content: (NPI 1114951845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114951845 NPI number — GERMANTOWN PHARMA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERMANTOWN PHARMA 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:
GERMANTOWN PHARMACY INC
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:
1114951845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 GERMANTOWN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19144-2327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-844-1319
Provider Business Mailing Address Fax Number:
215-438-3947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19144-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-844-1319
Provider Business Practice Location Address Fax Number:
215-438-3947
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOLI
Authorized Official First Name:
RANJEET
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-844-1319

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)

  • Identifier: 039111610911 . This is a "PACE PROGRAM PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1026106830001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139111610911 . This is a "RENAL PROGRAM PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".