Provider Demographics
NPI:1699036988
Name:CHALFONT IMMUNIZATION LLC
Entity Type:Organization
Organization Name:CHALFONT IMMUNIZATION LLC
Other - Org Name:VICKERY VACCINE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:VICKERY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:267-477-1010
Mailing Address - Street 1:50 KULP RD E
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3729
Mailing Address - Country:US
Mailing Address - Phone:267-477-1010
Mailing Address - Fax:215-491-5519
Practice Address - Street 1:50 KULP RD E
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3729
Practice Address - Country:US
Practice Address - Phone:267-477-1010
Practice Address - Fax:215-491-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-03
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA290619Medicare PIN