Provider Demographics
NPI:1700976925
Name:TJU HOSPITALS, INC
Entity Type:Organization
Organization Name:TJU HOSPITALS, INC
Other - Org Name:JEFFERSON APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-955-8845
Mailing Address - Street 1:111 S 11TH ST
Mailing Address - Street 2:GIBBON BLDG SUITE 1850
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-955-8845
Mailing Address - Fax:215-955-1711
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:GIBBON BLDG SUITE 1850
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-8845
Practice Address - Fax:215-955-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413308L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10075085400011Medicaid