1538380431 NPI number — HEALTH ON SOUTH RX LLC

Table of content: (NPI 1538380431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538380431 NPI number — HEALTH ON SOUTH RX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH ON SOUTH RX LLC
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:
6
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:
1538380431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1631-33 SOUTH ST
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:
19146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-496-9595
Provider Business Mailing Address Fax Number:
215-564-6065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1631-33 SOUTH ST
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:
19146-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-496-9595
Provider Business Practice Location Address Fax Number:
215-790-0900
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDMAN
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
RPH
Authorized Official Telephone Number:
215-962-6000

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PP415039L , 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: 3922855 . This is a "NDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1036746760001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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