Provider Demographics
NPI:1437674173
Name:COMMUNITY CARE RX LTC LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE RX LTC LLC
Other - Org Name:COMMUNITY CARE RX LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEKAREVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-255-2116
Mailing Address - Street 1:7601 CASTOR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-4026
Mailing Address - Country:US
Mailing Address - Phone:215-722-2500
Mailing Address - Fax:215-722-7700
Practice Address - Street 1:7601 CASTOR AVE STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-4026
Practice Address - Country:US
Practice Address - Phone:215-722-2500
Practice Address - Fax:215-722-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4827733336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170894OtherPK