Provider Demographics
NPI:1003214214
Name:CCN AMERICA LP
Entity Type:Organization
Organization Name:CCN AMERICA LP
Other - Org Name:COORDINATED CARE NETWORK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-349-6300
Mailing Address - Street 1:300 PENN CENTER BLVD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5511
Mailing Address - Country:US
Mailing Address - Phone:412-349-6300
Mailing Address - Fax:412-349-6724
Practice Address - Street 1:249 S 13TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5640
Practice Address - Country:US
Practice Address - Phone:844-657-6786
Practice Address - Fax:267-324-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4825323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018103020002Medicaid
2149363OtherPK