Provider Demographics
NPI:1225028558
Name:SOUSAN PHARMACY INC
Entity Type:Organization
Organization Name:SOUSAN PHARMACY INC
Other - Org Name:SOUSAN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-635-4200
Mailing Address - Street 1:8029 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1413
Mailing Address - Country:US
Mailing Address - Phone:215-635-4200
Mailing Address - Fax:215-635-3654
Practice Address - Street 1:8029 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1413
Practice Address - Country:US
Practice Address - Phone:215-635-4200
Practice Address - Fax:215-635-3654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412344L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3914024OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3914024OtherNCPDP PROVIDER IDENTIFICATION NUMBER