Provider Demographics
NPI:1770236044
Name:TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Entity Type:Organization
Organization Name:TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-796-2085
Mailing Address - Street 1:625 CLARK AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4025
Mailing Address - Country:US
Mailing Address - Phone:610-992-3920
Mailing Address - Fax:
Practice Address - Street 1:625 CLARK AVE STE 10
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4025
Practice Address - Country:US
Practice Address - Phone:610-992-3920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001258770270Medicaid