Provider Demographics
NPI:1891753992
Name:MEDCARE LTC
Entity Type:Organization
Organization Name:MEDCARE LTC
Other - Org Name:MEDCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, JD
Authorized Official - Phone:215-844-4500
Mailing Address - Street 1:PO BOX 26639
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-6639
Mailing Address - Country:US
Mailing Address - Phone:215-844-4500
Mailing Address - Fax:215-844-4080
Practice Address - Street 1:5325 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2900
Practice Address - Country:US
Practice Address - Phone:215-844-4500
Practice Address - Fax:215-844-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP-4811063336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018733550001Medicaid
PA1891753992OtherNPI
PAPP481106OtherSTATE PHARMACY LICENSE NO
PA1891753992OtherNPI