Provider Demographics
NPI:1407088156
Name:MEDARBOR LLC
Entity Type:Organization
Organization Name:MEDARBOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KESIC
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:610-660-8100
Mailing Address - Street 1:200 RITTENHOUSE CIR STE 3E
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-1625
Mailing Address - Country:US
Mailing Address - Phone:610-660-8100
Mailing Address - Fax:866-740-4689
Practice Address - Street 1:200 RITTENHOUSE CIR BLDG SUITEE3
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-1619
Practice Address - Country:US
Practice Address - Phone:610-660-8100
Practice Address - Fax:866-740-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4819663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102401469Medicaid
2121939OtherPK