Provider Demographics
NPI:1801493606
Name:SOMERSET PHARMACY LLC
Entity type:Organization
Organization Name:SOMERSET PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:267-534-4030
Mailing Address - Street 1:216 W SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-3534
Mailing Address - Country:US
Mailing Address - Phone:267-534-4030
Mailing Address - Fax:
Practice Address - Street 1:216 W SOMERSET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3534
Practice Address - Country:US
Practice Address - Phone:267-534-4030
Practice Address - Fax:267-687-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103877660-0001Medicaid