Provider Demographics
NPI:1548396955
Name:P&K PHARMACY INC
Entity Type:Organization
Organization Name:P&K PHARMACY INC
Other - Org Name:MAIN LINE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-658-8640
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-658-8640
Mailing Address - Fax:610-658-8644
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-658-8640
Practice Address - Fax:610-658-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP415726L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3978395OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3978395OtherOTHER ID NUMBER
PA101282640Medicaid