Provider Demographics
NPI:1174635387
Name:OMNICARE PHARMACIES OF PA WEST LLC
Entity Type:Organization
Organization Name:OMNICARE PHARMACIES OF PA WEST LLC
Other - Org Name:OMNICARE OF PITTSBURGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2751
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:BOX 1075
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4700 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9659
Practice Address - Country:US
Practice Address - Phone:412-919-0240
Practice Address - Fax:412-919-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
PAPP413803L3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3968813OtherNCPDP
WV3968813Medicaid
PA039688113818 (PACE)Medicaid
PA239688113818 (SBBP)Medicaid
PA739688113818 (LCAP)Medicaid
DE1000039282Medicaid
PA139688113818 (CRDP)Medicaid
PA1007759600013Medicaid
OH2198581Medicaid
NJ3968813Medicaid
CT3968813Medicaid
0427280003Medicare NSC