Provider Demographics
NPI:1649709460
Name:PENN MEDICAL PHARMACY LLC
Entity type:Organization
Organization Name:PENN MEDICAL PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEMIN VAIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIDYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-930-9417
Mailing Address - Street 1:385 OXFORD VALLEY RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7700
Mailing Address - Country:US
Mailing Address - Phone:215-960-9010
Mailing Address - Fax:215-960-9011
Practice Address - Street 1:385 OXFORD VALLEY RD UNIT 5
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7700
Practice Address - Country:US
Practice Address - Phone:215-960-9010
Practice Address - Fax:215-960-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PA35290743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169574OtherPK