Provider Demographics
NPI:1134189749
Name:NISENHOLTZ PHARMACY INC
Entity type:Organization
Organization Name:NISENHOLTZ PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:REGINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-342-7676
Mailing Address - Street 1:7624 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3623
Mailing Address - Country:US
Mailing Address - Phone:215-342-7676
Mailing Address - Fax:215-342-1593
Practice Address - Street 1:7624 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3623
Practice Address - Country:US
Practice Address - Phone:215-342-7676
Practice Address - Fax:215-342-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411697L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1912629201OtherPA ACCESS
PAPP411697LOtherPA STATE LICENSE
3963762OtherNCPDP NUMBER
PA0012629200001Medicaid
PA0140130001Medicare NSC