Provider Demographics
NPI:1043204670
Name:CONCEPT PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:CONCEPT PHARMACY SERVICES LLC
Other - Org Name:CONCEPT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HILLEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-875-3611
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921-0201
Mailing Address - Country:US
Mailing Address - Phone:570-875-3611
Mailing Address - Fax:570-875-2885
Practice Address - Street 1:639 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:PA
Practice Address - Zip Code:17921
Practice Address - Country:US
Practice Address - Phone:570-875-3611
Practice Address - Fax:570-875-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 333600000X, 3336H0001X
PAPP415613L3336L0003X, 335E00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001785065Medicaid
2084949OtherPK
PA001785065Medicaid