Provider Demographics
NPI:1033116702
Name:LOMBARD APOTHECARY INC
Entity Type:Organization
Organization Name:LOMBARD APOTHECARY INC
Other - Org Name:LOMBARD APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-732-7888
Mailing Address - Street 1:PO BOX 7908
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-7908
Mailing Address - Country:US
Mailing Address - Phone:215-732-7888
Mailing Address - Fax:215-732-9772
Practice Address - Street 1:1745 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1528
Practice Address - Country:US
Practice Address - Phone:215-732-7888
Practice Address - Fax:215-732-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481188L333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP411697LOtherPA PHARMACY LICENSE
PA1019565950001Medicaid
PA3000008269OtherPA DRUG & DEVICE REGISTRATION - DISTRIBUTOR
PA8000001938OtherPA DRUG & DEVICE LICENSE - WHOLESALER/DISTRIBUTOR
PA84136809OtherPA SALES TAX LICENSE
3981075OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3981075OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1019565950001Medicaid