Provider Demographics
NPI:1396032892
Name:FRONT ST PHARMACY LLC
Entity Type:Organization
Organization Name:FRONT ST PHARMACY LLC
Other - Org Name:FRONT STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BULENT
Authorized Official - Middle Name:
Authorized Official - Last Name:YAVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-960-4444
Mailing Address - Street 1:4823 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4213
Mailing Address - Country:US
Mailing Address - Phone:215-960-4444
Mailing Address - Fax:215-960-4445
Practice Address - Street 1:4823 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-4213
Practice Address - Country:US
Practice Address - Phone:215-960-4444
Practice Address - Fax:215-960-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4822393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026884070001Medicaid
2133435OtherPK