Provider Demographics
NPI:1770653388
Name:SUBURBAN MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SUBURBAN MEDICAL SERVICES, LLC
Other - Org Name:OMNICARE OF KING OF PRUSSIA #48333
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2751
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:BOX 1075
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 ALLENDALE RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1418
Practice Address - Country:US
Practice Address - Phone:610-992-0856
Practice Address - Fax:610-962-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
DEA9-0000631332BP3500X, 3336L0003X
PAPP413534L332BP3500X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0395095Medicaid
PA2395095Medicaid
DE0000194607Medicaid
PA1007277110005Medicaid
3950955OtherNCPDP
PA7395095Medicaid
PA1395095Medicaid
NJ4452909Medicaid
PA0395095Medicaid