Provider Demographics
NPI:1790146736
Name:YORKTOWN PHARMACY LLC
Entity Type:Organization
Organization Name:YORKTOWN PHARMACY LLC
Other - Org Name:YORKTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BINTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:267-282-0070
Mailing Address - Street 1:8110 OLD YORK RD STE B
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1430
Mailing Address - Country:US
Mailing Address - Phone:267-282-0070
Mailing Address - Fax:267-282-0071
Practice Address - Street 1:8110 OLD YORK RD STE B
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1430
Practice Address - Country:US
Practice Address - Phone:267-282-0070
Practice Address - Fax:267-282-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4826283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159002OtherPK
PA1031162090001Medicaid