NPIMap

Organization Active NPI

Philadelphia Department of Public Health Center Pharmacy #4

  • Clinic Pharmacy
  • Philadelphia, PA
National Provider Identifier
1164518866
Registry record updated Mar 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
Legal business name
PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH CENTER PHARMACY #4
Practice address
4400 Haverford Avenue
Pharmacy
Philadelphia, PA 19104
Phone
(215) 685-7926
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2019

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

Authorized official

Name
Mr. Jeffrey T. Pender, RPH
Title
Director of Pharmaceutical Services
Phone
(215) 685-6864

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X HP418324L PA
Clinic Pharmacy 3336C0002X Primary

Addresses

Primary practice location

4400 Haverford Avenue
Pharmacy
Philadelphia, PA 19104

Mailing address

500 S. Broad Street
Pharmacy/Basement
Philadelphia, PA 19146
Phone (215) 685-6864

Other identifiers 1

IdentifierTypeStateIssuer
1000076950039MedicaidPA

Other names 1

  • Pharmacy Health Center #4 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Health Center 223 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

500 S Broad St
Philadelphia, PA 19146
Phone (215) 685-6864

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551916800000",
    "number": "1164518866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S. BROAD STREET",
            "address_2": "PHARMACY/BASEMENT",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19146",
            "telephone_number": "215-685-6864",
            "fax_number": "215-790-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 HAVERFORD AVENUE",
            "address_2": "PHARMACY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-685-7926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH CENTER PHARMACY #4",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2019-03-07",
        "status": "A",
        "authorized_official_last_name": "PENDER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACEUTICAL SERVICES",
        "authorized_official_telephone_number": "215-685-6864",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "PA",
            "license": "HP418324L",
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000076950039",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmacy Health Center #4",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pharmacy Health Center #4",
            "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 Mar 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.