Provider Demographics
NPI:1457362154
Name:NORTH WEST PHARMACY INC.
Entity Type:Organization
Organization Name:NORTH WEST PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-232-9222
Mailing Address - Street 1:2024 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-1407
Mailing Address - Country:US
Mailing Address - Phone:215-232-9222
Mailing Address - Fax:215-232-9822
Practice Address - Street 1:2024 N 22ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-1407
Practice Address - Country:US
Practice Address - Phone:215-232-9222
Practice Address - Fax:215-232-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411913L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0558385Medicaid
PA3940182OtherNABP
PA3940182OtherNABP