Provider Demographics
NPI:1841296043
Name:LANSDOWNE AVE PHARMACY
Entity type:Organization
Organization Name:LANSDOWNE AVE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-877-2700
Mailing Address - Street 1:5943 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3932
Mailing Address - Country:US
Mailing Address - Phone:215-877-0700
Mailing Address - Fax:215-877-4700
Practice Address - Street 1:5943 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3932
Practice Address - Country:US
Practice Address - Phone:215-877-0700
Practice Address - Fax:215-877-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481416333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3983738OtherNCPDB
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