NPIMap

Organization Active NPI

Department of Military Affairs Commonwealth of Pennsylvania

  • Long Term Care Pharmacy
  • Philadelphia, PA
National Provider Identifier
1114282191
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
DEPARTMENT OF MILITARY AFFAIRS COMMONWEALTH OF PENNSYLVANIA
Practice address
2701 Southampton Rd
Philadelphia, PA 19154-1205
Phone
(215) 965-5900
NPI assigned
Jul 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Reed Jr.
Title
Fiscal Services Administrator
Phone
(814) 242-7789

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PP481847 PA
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

2701 Southampton Rd
Philadelphia, PA 19154-1205

Mailing address

2701 Southampton Rd
Philadelphia, PA 19154-1205

Other names 1

  • Delaware Valley Veterns Home Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120919000056 PA Part B Supplier - Pharmacy 1557320348 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spring City, PA; Scranton, PA; Pittsburgh, PA; Erie, PA; Duncansville, PA; Philadelphia, PA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ilhoon Kim12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

138 Veterans Blvd
Duncansville, PA 16635
Phone (814) 696-5219

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653350400000",
    "number": "1114282191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 SOUTHAMPTON RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191541205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 SOUTHAMPTON RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191541205",
            "telephone_number": "215-965-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF MILITARY AFFAIRS COMMONWEALTH OF PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-06",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "FISCAL SERVICES ADMINISTRATOR",
        "authorized_official_telephone_number": "814-242-7789",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP481847",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delaware Valley Veterns Home Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Delaware Valley Veterns Home Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.