Provider Demographics
NPI:1922008507
Name:BARDA INC
Entity Type:Organization
Organization Name:BARDA INC
Other - Org Name:WESTBROOK PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-626-2949
Mailing Address - Street 1:244 W BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-2101
Mailing Address - Country:US
Mailing Address - Phone:610-626-2949
Mailing Address - Fax:610-626-2950
Practice Address - Street 1:244 W BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19018-2101
Practice Address - Country:US
Practice Address - Phone:610-626-2949
Practice Address - Fax:610-626-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP412859L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0775880Medicaid
2083847OtherPK
2083847OtherPK