Provider Demographics
NPI:1306216866
Name:ENCLARA PHARMACIA, INC
Entity Type:Organization
Organization Name:ENCLARA PHARMACIA, INC
Other - Org Name:ENCLARA PHARMACIA, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANGER, LICENSING
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-996-1187
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1320
Mailing Address - Country:US
Mailing Address - Phone:877-882-7822
Mailing Address - Fax:215-282-1587
Practice Address - Street 1:1601 CHERRY ST
Practice Address - Street 2:SUITE 1800
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1320
Practice Address - Country:US
Practice Address - Phone:877-882-7822
Practice Address - Fax:215-282-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
PAPP4814583336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154057OtherPK