Provider Demographics
NPI:1114987567
Name:TRIPLE A PHARMACY
Entity Type:Organization
Organization Name:TRIPLE A PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-724-7507
Mailing Address - Street 1:702 S 49TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3418
Mailing Address - Country:US
Mailing Address - Phone:215-724-7507
Mailing Address - Fax:215-724-5397
Practice Address - Street 1:702 S 49TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3418
Practice Address - Country:US
Practice Address - Phone:215-724-7507
Practice Address - Fax:215-724-5397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413405L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3912563OtherNABP/NCPDP
PA0577649Medicaid