Provider Demographics
NPI:1932192986
Name:SAMUEL J. ROBINSON PHARMACY INC
Entity Type:Organization
Organization Name:SAMUEL J. ROBINSON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-228-7177
Mailing Address - Street 1:2848 W LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-3130
Mailing Address - Country:US
Mailing Address - Phone:215-228-7177
Mailing Address - Fax:215-228-7178
Practice Address - Street 1:2848 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-3130
Practice Address - Country:US
Practice Address - Phone:215-228-7177
Practice Address - Fax:215-228-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412112L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005727870002Medicaid
PA0911100001Medicare ID - Type Unspecified