Provider Demographics
NPI:1003977992
Name:SCR PENNSYLVANIA INC
Entity Type:Organization
Organization Name:SCR PENNSYLVANIA INC
Other - Org Name:RUBINOS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:SELLECCHIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-624-0919
Mailing Address - Street 1:7100 TORRESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1313
Mailing Address - Country:US
Mailing Address - Phone:215-624-0919
Mailing Address - Fax:
Practice Address - Street 1:7100 TORRESDALE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1313
Practice Address - Country:US
Practice Address - Phone:215-624-0919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412161L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5274800001Medicare NSC