Provider Demographics
NPI:1215373121
Name:AMERICURE RX PENNSYLVANIA LLC
Entity Type:Organization
Organization Name:AMERICURE RX PENNSYLVANIA LLC
Other - Org Name:AMERICURE RX PENSSYLVANIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOBUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DU PLESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-223-4940
Mailing Address - Street 1:6620 GRANT WAY
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9316
Mailing Address - Country:US
Mailing Address - Phone:484-223-4940
Mailing Address - Fax:484-223-1049
Practice Address - Street 1:6620 GRANT WAY
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9316
Practice Address - Country:US
Practice Address - Phone:484-223-4940
Practice Address - Fax:484-223-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-18
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X
PAPP4823603336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140387OtherPK