Provider Demographics
NPI:1760576052
Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Other - Org Name:THE CHILDRENS HOSPITAL OF PHILADELPHIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, RETAIL PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:215-590-5288
Mailing Address - Street 1:PO BOX 785166
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-2033
Mailing Address - Country:US
Mailing Address - Phone:215-590-5288
Mailing Address - Fax:215-590-1906
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:267-425-8888
Practice Address - Fax:215-590-0455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL OF PHILADELPHIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4816283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2081592OtherPK
PA1007709910084Medicaid
PA0575223Medicaid