Provider Demographics
NPI:1871631549
Name:PENNSWOOD VILLAGE
Entity Type:Organization
Organization Name:PENNSWOOD VILLAGE
Other - Org Name:PENNSWOOD VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUMP
Authorized Official - Suffix:
Authorized Official - Credentials:RPH CGP
Authorized Official - Phone:215-504-1102
Mailing Address - Street 1:1382 NEWTOWN LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2418
Mailing Address - Country:US
Mailing Address - Phone:215-504-1102
Mailing Address - Fax:215-504-6870
Practice Address - Street 1:1382 NEWTOWN LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-2418
Practice Address - Country:US
Practice Address - Phone:215-504-1102
Practice Address - Fax:215-504-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336I0012X
PAHP416583L3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3943366OtherNCPDP PROVIDER IDENTIFICATION NUMBER