Provider Demographics
NPI:1326093170
Name:ACADEMY PHARMACY LLC
Entity Type:Organization
Organization Name:ACADEMY PHARMACY LLC
Other - Org Name:ACADEMY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-632-2121
Mailing Address - Street 1:10101 ACADEMY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1120
Mailing Address - Country:US
Mailing Address - Phone:215-632-2121
Mailing Address - Fax:215-632-6107
Practice Address - Street 1:10101 ACADEMY RD
Practice Address - Street 2:STE 105
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1120
Practice Address - Country:US
Practice Address - Phone:215-632-2121
Practice Address - Fax:215-632-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4815823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087764OtherPK
PA1015794080001Medicaid
5692500001Medicare ID - Type Unspecified