Provider Demographics
NPI:1396178133
Name:ACH PHARMA INC
Entity Type:Organization
Organization Name:ACH PHARMA INC
Other - Org Name:WYNNEFIELD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEMANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMBARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-353-8159
Mailing Address - Street 1:2230 BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2308
Mailing Address - Country:US
Mailing Address - Phone:267-353-8159
Mailing Address - Fax:267-353-8177
Practice Address - Street 1:2230 BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2308
Practice Address - Country:US
Practice Address - Phone:267-353-8159
Practice Address - Fax:267-353-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482396333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy