Provider Demographics
NPI:1013349323
Name:CHESTER PIKE PHARMACY LLC
Entity Type:Organization
Organization Name:CHESTER PIKE PHARMACY LLC
Other - Org Name:MACDADE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:DJELHI YAHOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-300-9371
Mailing Address - Street 1:637 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-3417
Mailing Address - Country:US
Mailing Address - Phone:610-522-5200
Mailing Address - Fax:610-522-5202
Practice Address - Street 1:637 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-3417
Practice Address - Country:US
Practice Address - Phone:610-522-5200
Practice Address - Fax:610-522-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4824313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102867515-0001Medicaid
2142363OtherPK