Provider Demographics
NPI:1659451896
Name:GERMANTOWN COMMUNITY HEALTH SVS
Entity Type:Organization
Organization Name:GERMANTOWN COMMUNITY HEALTH SVS
Other - Org Name:GERMANTOWN COMMUNITY HEALTH SERVICES PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT HEALTHCARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-456-6015
Mailing Address - Street 1:1 PENN BLVD
Mailing Address - Street 2:GERMANTOWN PHARMACY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1476
Mailing Address - Country:US
Mailing Address - Phone:215-951-8030
Mailing Address - Fax:215-951-8083
Practice Address - Street 1:1 PENN BLVD
Practice Address - Street 2:GERMATOWN PHARMACY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1476
Practice Address - Country:US
Practice Address - Phone:215-951-8030
Practice Address - Fax:215-951-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHP418074L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007544140015Medicaid
PA1007544140015Medicaid