Provider Demographics
NPI:1194225318
Name:UPMC COMMUNITY PROVIDER SERVICES
Entity Type:Organization
Organization Name:UPMC COMMUNITY PROVIDER SERVICES
Other - Org Name:UPMC RX EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING & FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-647-2940
Mailing Address - Street 1:200 OLD POND RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1269
Mailing Address - Country:US
Mailing Address - Phone:412-328-4788
Mailing Address - Fax:
Practice Address - Street 1:3507 VICTORIA ST.
Practice Address - Street 2:ROOM 105
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:833-831-8117
Practice Address - Fax:855-450-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
PA24323163336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176018OtherPK