Provider Demographics
NPI:1811376296
Name:HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA PHARMACY
Entity Type:Organization
Organization Name:HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA PHARMACY
Other - Org Name:HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA PHARMACY PCAM 3E
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-662-2900
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:PHARMACY GROUND RHOADS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:215-662-2900
Mailing Address - Fax:215-349-5852
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:PCAM 3E
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4238
Practice Address - Country:US
Practice Address - Phone:215-615-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4820063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151969OtherPK