Provider Demographics
NPI:1801202817
Name:PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S
Entity Type:Organization
Organization Name:PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S
Other - Org Name:PENN MEDICINE AT UNIVERSITY CITY-APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:NISHAMINY
Authorized Official - Middle Name:
Authorized Official - Last Name:KASBEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-662-9780
Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:DEPARTMENT OF PHARMACY - BASEMENT CUPP BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-8213
Mailing Address - Fax:215-243-4644
Practice Address - Street 1:3737 MARKET ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5545
Practice Address - Country:US
Practice Address - Phone:215-294-9375
Practice Address - Fax:215-222-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336C0004X
PAPP4824743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146785OtherPK