Provider Demographics
NPI:1477921666
Name:PA HEALTHCARE PHARMACEUTICAL COMPANY
Entity Type:Organization
Organization Name:PA HEALTHCARE PHARMACEUTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-741-9117
Mailing Address - Street 1:7183 NAVAJO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1696
Mailing Address - Country:US
Mailing Address - Phone:619-741-9117
Mailing Address - Fax:888-502-2754
Practice Address - Street 1:7183 NAVAJO RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1696
Practice Address - Country:US
Practice Address - Phone:619-741-9117
Practice Address - Fax:888-502-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100057238Medicaid
NE10026579700Medicaid
PA103275591-0001Medicaid
CA1477921666Medicaid
LA2413601Medicaid
NE10026579700Medicaid