Provider Demographics
NPI:1043578826
Name:SPRINGFIELD PHARMACEUTICALS LLC
Entity Type:Organization
Organization Name:SPRINGFIELD PHARMACEUTICALS LLC
Other - Org Name:SPRINGFIELD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIMDIMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILONZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-544-4645
Mailing Address - Street 1:1154 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2850
Mailing Address - Country:US
Mailing Address - Phone:610-544-4645
Mailing Address - Fax:610-544-1757
Practice Address - Street 1:1154 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2850
Practice Address - Country:US
Practice Address - Phone:610-544-4645
Practice Address - Fax:610-544-1757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4822653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134959OtherPK
3997307OtherNCPDP PROVIDER IDENTIFICATION NUMBER