Provider Demographics
NPI:1134313588
Name:UNITED PHARMACY UPPERDARBY INC
Entity Type:Organization
Organization Name:UNITED PHARMACY UPPERDARBY INC
Other - Org Name:UNITED PHARMACY UPPER DARBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-438-3880
Mailing Address - Street 1:206B W CHELTEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3803
Mailing Address - Country:US
Mailing Address - Phone:215-438-3880
Mailing Address - Fax:215-438-3883
Practice Address - Street 1:206B W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3803
Practice Address - Country:US
Practice Address - Phone:215-438-3880
Practice Address - Fax:215-438-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
PAPP4817523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3989033OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA1020677540001Medicaid
PA1020677540001Medicaid