Provider Demographics
NPI:1639196090
Name:NEFF DRUGS 23 LLC DBA HOLMESBURG PHARMACY
Entity Type:Organization
Organization Name:NEFF DRUGS 23 LLC DBA HOLMESBURG PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:TANCREDI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-332-2400
Mailing Address - Street 1:8039 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2736
Mailing Address - Country:US
Mailing Address - Phone:215-332-2400
Mailing Address - Fax:215-332-6030
Practice Address - Street 1:8039 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2736
Practice Address - Country:US
Practice Address - Phone:215-332-2400
Practice Address - Fax:215-332-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4815943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016176340001Medicaid