Provider Demographics
NPI:1225312952
Name:PHARMDIRECT RX
Entity Type:Organization
Organization Name:PHARMDIRECT RX
Other - Org Name:PHARMDIRECT, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYREESE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:215-732-0300
Mailing Address - Street 1:2308 GRAYS FERRY AVE
Mailing Address - Street 2:P3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1177
Mailing Address - Country:US
Mailing Address - Phone:215-732-0300
Mailing Address - Fax:215-732-0305
Practice Address - Street 1:2308 GRAYS FERRY AVE
Practice Address - Street 2:P3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1177
Practice Address - Country:US
Practice Address - Phone:215-732-0300
Practice Address - Fax:215-732-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4821753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP482175OtherPA PHARMACY LICENSE NUMBER