Provider Demographics
NPI:1174629000
Name:ZEVIN'S DRUG STORE, INC.
Entity Type:Organization
Organization Name:ZEVIN'S DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KERCHUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-468-0622
Mailing Address - Street 1:800 MCKEAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2342
Mailing Address - Country:US
Mailing Address - Phone:215-468-0622
Mailing Address - Fax:215-468-0175
Practice Address - Street 1:800 MCKEAN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2342
Practice Address - Country:US
Practice Address - Phone:215-468-0622
Practice Address - Fax:215-468-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412990L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3907637OtherNCPDP/NABP NUMBER
PA3907637OtherNCPDP/NABP NUMBER