Provider Demographics
NPI:1245497361
Name:CROZER HEALTH PHARMACY
Entity type:Organization
Organization Name:CROZER HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM OF DIRECTOR OF PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:CUMBERBATCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:610-447-2855
Mailing Address - Street 1:1 MEDICAL CENTER BLVD (GROUND FLOOR)
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-447-2850
Mailing Address - Fax:610-447-2861
Practice Address - Street 1:1 MEDICAL CENTER BLVD (GROUND FLOOR)
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-447-2850
Practice Address - Fax:610-447-2861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSPECT CCMC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-16
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHP418048L3336C0003X
3336S0011X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3972848OtherNABP