Provider Demographics
NPI:1710221262
Name:SAN JUAN DE DIOS LLC
Entity Type:Organization
Organization Name:SAN JUAN DE DIOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPATHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-206-3861
Mailing Address - Street 1:2122 GALLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2988
Mailing Address - Country:US
Mailing Address - Phone:267-206-3861
Mailing Address - Fax:
Practice Address - Street 1:961 N 10TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-2353
Practice Address - Country:US
Practice Address - Phone:610-743-4501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-22
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4823303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy