Provider Demographics
NPI:1568527745
Name:EXTON PHARMACY LLC
Entity Type:Organization
Organization Name:EXTON PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-363-9444
Mailing Address - Street 1:1 MARCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1840
Mailing Address - Country:US
Mailing Address - Phone:610-363-9444
Mailing Address - Fax:
Practice Address - Street 1:1 MARCHWOOD RD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1840
Practice Address - Country:US
Practice Address - Phone:610-363-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101025571-0001Medicaid
PA101025571-0001Medicaid