Provider Demographics
NPI:1144677030
Name:EXCEL PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:EXCEL PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:HOON
Authorized Official - Last Name:GIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-270-6300
Mailing Address - Street 1:354 W LANCASTER AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1300
Mailing Address - Country:US
Mailing Address - Phone:484-270-6300
Mailing Address - Fax:484-270-6303
Practice Address - Street 1:354 W LANCASTER AVE STE 120
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1300
Practice Address - Country:US
Practice Address - Phone:484-270-6300
Practice Address - Fax:484-270-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA9-0001878333600000X
OH0226448503336C0003X
NJ28RO001462003336C0003X
NE10513336C0003X
IL054.0201043336C0003X
KYPA21433336C0003X
MO20160250663336C0003X
PAPP4826563336C0003X
ID42933MS3336C0003X
WI1762-433336C0003X
WVMO05610423336C0003X
AZY0069273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160255OtherPK