Provider Demographics
NPI:1356632913
Name:CASTOR PHARMACY & SURGICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:CASTOR PHARMACY & SURGICAL SUPPLIES LLC
Other - Org Name:CASTOR PHARMACY & SURGICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/PHARMACY MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:267-269-7890
Mailing Address - Street 1:6449 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2738
Mailing Address - Country:US
Mailing Address - Phone:267-233-1758
Mailing Address - Fax:
Practice Address - Street 1:6449 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2738
Practice Address - Country:US
Practice Address - Phone:267-233-1758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3995454OtherNCPDP PROVIDER IDENTIFICATION NUMBER