1891918249 NPI number — MERAKEY CHILDRENS SERVICES

Table of content: JEANNETTE LORRAINE BOUCHARD PHARMD (NPI 1144730656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891918249 NPI number — MERAKEY CHILDRENS SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERAKEY CHILDRENS SERVICES
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:
NHS CHILDRENS REACH
Provider Other Organization Name Type Code:
4
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:
1891918249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 GERMANTOWN PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19444-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-836-3131
Provider Business Mailing Address Fax Number:
215-273-5975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1616 GREGG 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:
19115-4210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-836-3131
Provider Business Practice Location Address Fax Number:
215-273-5975
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TILSON
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CORP SR. DIRECTOR OF BUSINESS OPS
Authorized Official Telephone Number:
215-836-3131

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007469130020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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