Provider Demographics
NPI:1093453011
Name:PENN PRESPYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEA
Entity Type:Organization
Organization Name:PENN PRESPYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-662-9108
Mailing Address - Street 1:51 N 39TH STREET
Mailing Address - Street 2:CUPP BASEMENT-PHARMACY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-8213
Mailing Address - Fax:215-243-4644
Practice Address - Street 1:1865 ROUTE 70 EAST
Practice Address - Street 2:SUITE 180
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-433-2877
Practice Address - Fax:856-396-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy