Provider Demographics
NPI:1760834402
Name:CLINICAL SUPPORT CENTER INC
Entity Type:Organization
Organization Name:CLINICAL SUPPORT CENTER INC
Other - Org Name:RXBOX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KILIMNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-579-2692
Mailing Address - Street 1:225 OLD SOLDIERS RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-2130
Mailing Address - Country:US
Mailing Address - Phone:267-579-2692
Mailing Address - Fax:
Practice Address - Street 1:225 OLD SOLDIERS RD
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-2130
Practice Address - Country:US
Practice Address - Phone:267-579-2692
Practice Address - Fax:267-579-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4826623336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031287470001Medicaid
2160969OtherPK
528473Medicare PIN