Provider Demographics
NPI:1932570546
Name:11TH STREET PHARMACY LLC
Entity type:Organization
Organization Name:11TH STREET PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ACCAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-500-2223
Mailing Address - Street 1:PO BOX 3704
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-0704
Mailing Address - Country:US
Mailing Address - Phone:215-769-2155
Mailing Address - Fax:267-793-0048
Practice Address - Street 1:850 N 11TH ST FL 1
Practice Address - Street 2:RM 148
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1957
Practice Address - Country:US
Practice Address - Phone:215-769-2155
Practice Address - Fax:267-793-0048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AA PHARMACY HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-08
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X
PA333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy