Provider Demographics
NPI:1245396555
Name:CAMILLA HALL INFIRMARY
Entity Type:Organization
Organization Name:CAMILLA HALL INFIRMARY
Other - Org Name:CAMILLA HALL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:484-321-5656
Mailing Address - Street 1:100 MAXIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355
Mailing Address - Country:US
Mailing Address - Phone:484-321-5656
Mailing Address - Fax:484-321-5657
Practice Address - Street 1:100 MAXIS DRIVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355
Practice Address - Country:US
Practice Address - Phone:484-321-5656
Practice Address - Fax:484-321-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414299L3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2079703OtherPK
PA1230524Medicaid
0938160001Medicare NSC