Provider Demographics
NPI:1679546360
Name:WASHINGTON SQUARE PHARMACY INC
Entity Type:Organization
Organization Name:WASHINGTON SQUARE PHARMACY INC
Other - Org Name:WASHINGTON SQUARE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLGRAF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-925-1466
Mailing Address - Street 1:241 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3727
Mailing Address - Country:US
Mailing Address - Phone:215-925-1466
Mailing Address - Fax:215-829-0820
Practice Address - Street 1:241 S 6TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3727
Practice Address - Country:US
Practice Address - Phone:215-925-1466
Practice Address - Fax:215-829-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-11
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP411092L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000528970002Medicaid
2079798OtherPK