1275591166 NPI number — RTA PHARMACY CARE, INC

Table of content: (NPI 1275591166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275591166 NPI number — RTA PHARMACY CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RTA PHARMACY CARE, 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:
RTA PHARMACY CARE
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:
1275591166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 WILMINGTON WEST CHESTER PIKE
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
CHADDS FORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-558-6222
Provider Business Mailing Address Fax Number:
610-558-6226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 EAST 10TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARCUS HOOK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-816-3997
Provider Business Practice Location Address Fax Number:
484-816-3998
Provider Enumeration Date:
05/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CICCONE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-558-6222

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PP415331L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PP415331L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PP415331L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PP415331L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0018412710001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2083713 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000024046 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".