Provider Demographics
NPI:1275591166
Name:RTA PHARMACY CARE, INC
Entity Type:Organization
Organization Name:RTA PHARMACY CARE, INC
Other - Org Name:RTA PHARMACY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CICCONE
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:610-558-6222
Mailing Address - Street 1:255 WILMINGTON WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317
Mailing Address - Country:US
Mailing Address - Phone:610-558-6222
Mailing Address - Fax:610-558-6226
Practice Address - Street 1:24 EAST 10TH STREET
Practice Address - Street 2:
Practice Address - City:MARCUS HOOK
Practice Address - State:PA
Practice Address - Zip Code:19061
Practice Address - Country:US
Practice Address - Phone:484-816-3997
Practice Address - Fax:484-816-3998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESPIRATORY THERAPY ASSOCIATES OF PA, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-02
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336L0003X
PAPP415331L333600000X, 3336C0003X, 3336H0001X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018412710001Medicaid
2083713OtherPK
DE1000024046Medicaid
DE1000024046Medicaid