Provider Demographics
NPI:1639698053
Name:PHARMACY OF NORRISTOWN, LLC
Entity Type:Organization
Organization Name:PHARMACY OF NORRISTOWN, LLC
Other - Org Name:PHARMACY OF NORRISTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALADUGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-231-1014
Mailing Address - Street 1:420 W MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-4640
Mailing Address - Country:US
Mailing Address - Phone:484-231-1014
Mailing Address - Fax:484-231-1865
Practice Address - Street 1:420 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4640
Practice Address - Country:US
Practice Address - Phone:484-231-1014
Practice Address - Fax:484-231-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4827043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103252514Medicaid