Provider Demographics
NPI:1467594796
Name:B. KUCHEROVSKY, INC
Entity Type:Organization
Organization Name:B. KUCHEROVSKY, INC
Other - Org Name:SUMMERDALE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRONISLAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHEROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-743-6349
Mailing Address - Street 1:900 E SANGER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1034
Mailing Address - Country:US
Mailing Address - Phone:215-743-6349
Mailing Address - Fax:215-533-8504
Practice Address - Street 1:900 E SANGER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1034
Practice Address - Country:US
Practice Address - Phone:215-743-6349
Practice Address - Fax:215-533-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411367L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18420090001Medicaid
PA4270030001Medicare NSC