Provider Demographics
NPI:1144590399
Name:CEDAR CARE PHARMACY LLC
Entity Type:Organization
Organization Name:CEDAR CARE PHARMACY LLC
Other - Org Name:CEDAR CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UCHECHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOBODO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-307-3334
Mailing Address - Street 1:543 S. 52ND STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143
Mailing Address - Country:US
Mailing Address - Phone:215-307-3334
Mailing Address - Fax:215-921-3661
Practice Address - Street 1:543 S 52ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1532
Practice Address - Country:US
Practice Address - Phone:215-307-3334
Practice Address - Fax:215-921-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4821903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3996634OtherNCPDP PROVIDER IDENTIFICATION NUMBER