Provider Demographics
NPI:1427598663
Name:SWEET HOME PHARMACY LLC
Entity Type:Organization
Organization Name:SWEET HOME PHARMACY LLC
Other - Org Name:SWEET HOME PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-466-2359
Mailing Address - Street 1:727 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3502
Mailing Address - Country:US
Mailing Address - Phone:484-466-2359
Mailing Address - Fax:484-466-3650
Practice Address - Street 1:727 CHURCH LN
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3502
Practice Address - Country:US
Practice Address - Phone:484-466-2359
Practice Address - Fax:484-466-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482709333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169550OtherPK