Provider Demographics
NPI:1831233048
Name:ELKINS PARK PHARMACY INC.
Entity type:Organization
Organization Name:ELKINS PARK PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDSIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BRODZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-782-1336
Mailing Address - Street 1:7901 HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2639
Mailing Address - Country:US
Mailing Address - Phone:215-782-1336
Mailing Address - Fax:215-782-1334
Practice Address - Street 1:7901 HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2639
Practice Address - Country:US
Practice Address - Phone:215-782-1336
Practice Address - Fax:215-782-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3964500OtherNABP