Provider Demographics
NPI:1073868667
Name:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN,PA
Entity Type:Organization
Organization Name:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN,PA
Other - Org Name:MERCY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BISCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:610-237-7330
Mailing Address - Street 1:1503 LANSDOWNE AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1330
Mailing Address - Country:US
Mailing Address - Phone:610-237-7330
Mailing Address - Fax:610-237-7333
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-237-7330
Practice Address - Fax:610-237-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4822553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy