Provider Demographics
NPI:1508583758
Name:UNITED RX OF PENNSYLVANIA LLC
Entity Type:Organization
Organization Name:UNITED RX OF PENNSYLVANIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CONTRACTING REPRESENTATIV
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-375-5736
Mailing Address - Street 1:44 PRIMOS AVE.
Mailing Address - Street 2:INDEPENDENCE CT BAYS 15-17
Mailing Address - City:FOLCROFT
Mailing Address - State:PA
Mailing Address - Zip Code:19032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 PRIMOS, INDEPENDENCE CT
Practice Address - Street 2:BAYS 15-17
Practice Address - City:FOLCROFT
Practice Address - State:PA
Practice Address - Zip Code:19032
Practice Address - Country:US
Practice Address - Phone:215-844-4500
Practice Address - Fax:888-808-5893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED RX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy