Provider Demographics
NPI:1053627943
Name:PBM ENTERPRISES
Entity Type:Organization
Organization Name:PBM ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:267-979-3948
Mailing Address - Street 1:364 WILMINGTON PIKE
Mailing Address - Street 2:A-5
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1261
Mailing Address - Country:US
Mailing Address - Phone:267-979-3948
Mailing Address - Fax:610-485-2459
Practice Address - Street 1:364 WILMINGTON PIKE
Practice Address - Street 2:A-5
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1261
Practice Address - Country:US
Practice Address - Phone:267-979-3948
Practice Address - Fax:610-485-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier