Provider Demographics
NPI:1891220190
Name:FRONTLINE PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:FRONTLINE PHARMACY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPANSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-699-3900
Mailing Address - Street 1:1100 E HECTOR ST STE 390
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2390
Mailing Address - Country:US
Mailing Address - Phone:267-699-3900
Mailing Address - Fax:267-699-3901
Practice Address - Street 1:1100 E HECTOR ST STE 390
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2390
Practice Address - Country:US
Practice Address - Phone:267-699-3900
Practice Address - Fax:267-699-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PAPP4827183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169064OtherPK