CCN AMERICA, LP

Provider Demographics

• NPI: 1194213652
• Name: CCN AMERICA, LP
• Entity Type: Organization
• Organization Name: CCN AMERICA, LP
• Other - Org Name: COORDINATED CARE NETWORK PHARMACY
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: VP
• Authorized Official - First Name: THOMAS
• Authorized Official - Last Name: POLLACK
• Authorized Official - Phone: 412-349-6300
• Mailing Address - Street 1: 300 PENN CENTER BLVD STE 505
• Mailing Address - City: PITTSBURGH
• Mailing Address - State: PA
• Mailing Address - Zip Code: 15235-5505
• Mailing Address - Country: US
• Mailing Address - Phone: 412-349-6300
• Mailing Address - Fax: 412-349-6311
• Practice Address - Street 1: 300 PENN CENTER BLVD STE 405
• Practice Address - City: PITTSBURGH
• Practice Address - State: PA
• Practice Address - Zip Code: 15235-5511
• Practice Address - Country: US
• Practice Address - Phone: 412-349-6300
• Practice Address - Fax: 412-349-6311
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2018-04-30
• Last Update Date: 2018-04-30

Provider Licenses

State	License ID	Taxonomies
AL	114317	3336S0011X
MN	264536	3336S0011X
MI	6301010585	3336S0011X
ME	MO40001734	3336S0011X
MD	P07388	3336S0011X
KY	PA1463	3336S0011X
KS	22-13060	3336S0011X
IN	64001140A	3336S0011X
IL	054.018830	3336S0011X
IA	4388	3336S0011X
GA	PHNR000903	3336S0011X
FL	PH26057	3336S0011X
DE	A9-0001443	3336S0011X
DC	NRX0000414	3336S0011X
CT	PCN.002683	3336S0011X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
VA	2016006960	Medicaid
	2177295	Other	PK
IN	300012108	Medicaid
KY	7100147740	Medicaid
IL	1114004082	Medicaid
NJ	0235504	Medicaid
PA	1018103020001	Medicaid
MN	1114004082	Medicaid
WV	3810008615	Medicaid
OH	2721540	Medicaid