Provider Demographics
NPI:1861867046
Name:EMPIRE PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:EMPIRE PHARMACY SERVICES LLC
Other - Org Name:EMPIRE PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JULIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-365-2600
Mailing Address - Street 1:375 E ELM ST STE 110D
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1973
Mailing Address - Country:US
Mailing Address - Phone:484-365-2600
Mailing Address - Fax:484-365-2602
Practice Address - Street 1:375 E ELM ST STE 110D
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1973
Practice Address - Country:US
Practice Address - Phone:484-365-2600
Practice Address - Fax:484-365-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2086333600000X
AZY006842333600000X
ORRP-0003165-CS333600000X
MO2016017571333600000X
MS14800/7.1333600000X
WI1664-43333600000X
UT9741909-1708333600000X
WA60636419333600000X
ID41608MS333600000X
IN64002081A333600000X
NJ28RO00137100333600000X
IL054019891333600000X
PAPP482616333600000X
TN0000005780333600000X
DEA9-00018293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155957OtherPK