Provider Demographics
NPI:1629452974
Name:CSP PHARMACY INC
Entity Type:Organization
Organization Name:CSP PHARMACY INC
Other - Org Name:GOOD HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:CHIRANJIVI
Authorized Official - Middle Name:BHARATH
Authorized Official - Last Name:JANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-874-2900
Mailing Address - Street 1:2224 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-2402
Mailing Address - Country:US
Mailing Address - Phone:610-497-1081
Mailing Address - Fax:610-494-4721
Practice Address - Street 1:2224 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2402
Practice Address - Country:US
Practice Address - Phone:610-497-1015
Practice Address - Fax:610-494-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4825653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153107OtherPK
PA1629452974Medicaid
PA1629452974Medicaid