Provider Demographics
NPI:1578895199
Name:DHANYABAPA LLC
Entity Type:Organization
Organization Name:DHANYABAPA LLC
Other - Org Name:E-Z PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHARDABEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-728-6300
Mailing Address - Street 1:1701 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3802
Mailing Address - Country:US
Mailing Address - Phone:215-728-6300
Mailing Address - Fax:215-728-6302
Practice Address - Street 1:1701 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3802
Practice Address - Country:US
Practice Address - Phone:215-728-6300
Practice Address - Fax:215-728-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482001332B00000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028201990001Medicaid
2140123OtherPK
PA1028201990001Medicaid