Provider Demographics
NPI:1114951845
Name:GERMANTOWN PHARMA INC
Entity Type:Organization
Organization Name:GERMANTOWN PHARMA INC
Other - Org Name:GERMANTOWN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANJEET
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-844-1319
Mailing Address - Street 1:5100 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2327
Mailing Address - Country:US
Mailing Address - Phone:215-844-1319
Mailing Address - Fax:215-438-3947
Practice Address - Street 1:5100 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2327
Practice Address - Country:US
Practice Address - Phone:215-844-1319
Practice Address - Fax:215-438-3947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039111610911OtherPACE PROGRAM PA
PA1026106830001Medicaid
PA139111610911OtherRENAL PROGRAM PA
PA6609160001Medicare NSC
3911167Medicare UPIN