1720082340 NPI number — BROAD & LEHIGH PHARMACY, INC

Table of content: (NPI 1720082340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720082340 NPI number — BROAD & LEHIGH PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROAD & LEHIGH PHARMACY, 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:
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:
1720082340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2031 E LEHIGH AVE
Provider Second Line Business Mailing Address:
SUITE 2G-1
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-489-1082
Provider Business Mailing Address Fax Number:
267-447-8779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2031 E LEHIGH AVE
Provider Second Line Business Practice Location Address:
SUITE 2G-1
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-489-1082
Provider Business Practice Location Address Fax Number:
267-447-8779
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NTEFO
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-228-9007

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PP415177L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001587523003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015875230001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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