Provider Demographics
NPI:1700500519
Name:EXPRESS CARE PHARMACY LLC
Entity Type:Organization
Organization Name:EXPRESS CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALADUGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-351-2273
Mailing Address - Street 1:1727 W LIBERTY ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5027
Mailing Address - Country:US
Mailing Address - Phone:610-351-2273
Mailing Address - Fax:610-351-2274
Practice Address - Street 1:1727 W LIBERTY ST UNIT 2
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5027
Practice Address - Country:US
Practice Address - Phone:610-351-2273
Practice Address - Fax:610-351-2274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPRESS CARE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102790868Medicaid