Tracemark Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP481991 Issued in PA

Legal business name

TRACEMARK PHARMACY

Practice address

4839 N Broad St
Philadelphia, PA 19141-2107

Phone

(215) 324-0800

Fax

(215) 324-0803

NPI assigned

Apr 28, 2010

Last updated

Apr 28, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bevis E Vanterpool, PHARM.D.NPI 1356673487

Title

Pharmacy Owner

Phone

(215) 668-4494

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bevis Vanterpool, PHARMD

  • Pharmacist
  • Philadelphia, PA
  • NPI 1356673487
  NPD (past) Authorized official

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272412800000",
    "number": "1215254305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4839 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191412107",
            "telephone_number": "215-324-0800",
            "fax_number": "215-324-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4839 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191412107",
            "telephone_number": "215-324-0800",
            "fax_number": "215-324-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACEMARK PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2010-04-28",
        "status": "A",
        "authorized_official_last_name": "VANTERPOOL",
        "authorized_official_first_name": "BEVIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PHARMACY OWNER",
        "authorized_official_telephone_number": "215-668-4494",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP481991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024349890001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• TPS III of PA, LLC (Hahnemann Primary Services)
• TPS IV of PA, LLC
• TPS IV of PA., LLC (University Orthopaedic Institute)
• Edouard J. Trabulsi, M.D.
• Karen May Trabulsi, M.D.
• Tracey Jones, M.D., P.C. (PsychPhilly)
• Dennis Allen Trach, D.C.
• Eric S Trachtenberg, PHARMD, RPH
• Jerry Milton Trachtenberg, DO
• Natalie Jane Trachtman, MD

• Community/Retail Pharmacy in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; 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.