Provider Demographics
NPI:1568491124
Name:WALNUT HOME THERAPEUTICS, INC
Entity Type:Organization
Organization Name:WALNUT HOME THERAPEUTICS, INC
Other - Org Name:JEFFERSON HOME INFUSION SERVICE AND JEFFERSON SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-1900
Mailing Address - Street 1:3500 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2659
Mailing Address - Country:US
Mailing Address - Phone:215-955-5200
Mailing Address - Fax:
Practice Address - Street 1:3500 HORIZON DR
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2659
Practice Address - Country:US
Practice Address - Phone:215-955-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414792-L251F00000X, 3336S0011X
PP414792-L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1568491124Medicaid
PA1007410040003Medicaid
NJ6046916Medicaid
NJ0436216Medicaid