Provider Demographics
NPI:1043394174
Name:DEJ INC
Entity Type:Organization
Organization Name:DEJ INC
Other - Org Name:CENTER APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:COCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-313-5512
Mailing Address - Street 1:800 W MOYAMENSING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3709
Mailing Address - Country:US
Mailing Address - Phone:215-334-1833
Mailing Address - Fax:215-334-5046
Practice Address - Street 1:800 W MOYAMENSING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3709
Practice Address - Country:US
Practice Address - Phone:215-334-1833
Practice Address - Fax:215-334-5046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP410356L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008659020003Medicaid
2086580OtherPK