1841296043 NPI number — LANSDOWNE AVE PHARMACY

Table of content: (NPI 1841296043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841296043 NPI number — LANSDOWNE AVE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANSDOWNE AVE PHARMACY
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:
Provider Other Organization Name Type Code:
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:
1841296043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5943 LANSDOWNE 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:
19151-3932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-877-0700
Provider Business Mailing Address Fax Number:
215-877-4700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5943 LANSDOWNE 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:
19151-3932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-877-0700
Provider Business Practice Location Address Fax Number:
215-877-4700
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FORBES
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-877-2700

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP481416 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3983738 . This is a "NCPDB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com