CCN AMERICA LP

Provider Demographics

• NPI: 1114004082
• Name: CCN AMERICA LP
• Entity Type: Organization
• Organization Name: CCN AMERICA LP
• Other - Org Name: COORDINATED CARE NETWORK PHARMACY
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT AND CFO
• Authorized Official - First Name: THOMAS
• Authorized Official - Last Name: POLLACK
• Authorized Official - Phone: 412-349-6300
• Mailing Address - Street 1: PO BOX 5000
• Mailing Address - City: GREENSBURG
• Mailing Address - State: PA
• Mailing Address - Zip Code: 15601-2117
• Mailing Address - Country: US
• Mailing Address - Phone: 412-349-6300
• Mailing Address - Fax: 412-349-6311
• Practice Address - Street 1: 300 PENN CENTER BLVD
• Practice Address - Street 2: STE 405
• Practice Address - City: PITTSBURGH
• Practice Address - State: PA
• Practice Address - Zip Code: 15235-5511
• Practice Address - Country: US
• Practice Address - Phone: 412-349-6337
• Practice Address - Fax: 412-349-6311
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-10-31
• Last Update Date: 2018-07-19

Provider Licenses

State	License ID	Taxonomies
IL	054.018830	3336C0003X
GA	PHNR000903	3336C0003X
ME	MO40001734	3336C0003X
KY	PA1463	3336C0003X
IA	4388	3336C0003X
AL	114317	3336C0003X
MS	13674	3336C0003X
MN	264536	3336C0003X
IN	64001140A	3336C0003X
MO	2013028515	3336C0003X
KS	22-13060	3336C0003X
FL	92900	3336C0003X
MI	5301010585	3336C0003X
MD	P07388	3336C0003X
DE	A9-0001443	3336C0003X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NJ	0235504	Medicaid
MN	1114004082	Medicaid
	2085919	Other	PK
VA	2016006960	Medicaid
PA	1018103020001	Medicaid
OH	2721540	Medicaid
WV	3810008615	Medicaid
IL	1114004082	Medicaid
KY	7100147740	Medicaid
IN	300012108	Medicaid