Provider Demographics
NPI:1013244979
Name:ACRO PHARMACEUTICAL SERVICES LLC.
Entity Type:Organization
Organization Name:ACRO PHARMACEUTICAL SERVICES LLC.
Other - Org Name:GPHA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:SHEKAR
Authorized Official - Last Name:CHIRRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-837-8392
Mailing Address - Street 1:4500 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3602
Mailing Address - Country:US
Mailing Address - Phone:215-743-4106
Mailing Address - Fax:215-743-4212
Practice Address - Street 1:4500 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3602
Practice Address - Country:US
Practice Address - Phone:215-743-4106
Practice Address - Fax:215-743-4212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACRO PHARMACEUTICAL SERVICES LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481961333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010414210001Medicaid
PA5377840001OtherMEDICARE ID TYPE UNSPECIFIED