Provider Demographics
NPI:1902815913
Name:TERRAPIN WEST END PHARMACY, LLC
Entity Type:Organization
Organization Name:TERRAPIN WEST END PHARMACY, LLC
Other - Org Name:ALTRUIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-300-0102
Mailing Address - Street 1:3800 HORIZON BLVD STE 103B
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 HORIZON BLVD STE 103B
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4968
Practice Address - Country:US
Practice Address - Phone:610-433-1826
Practice Address - Fax:610-433-0386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP-412851-L3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1044400001Medicare NSC