NPIMap

Organization Active NPI

Camilla Hall Infirmary

  • Long Term Care Pharmacy
  • Malvern, PA
National Provider Identifier
1245396555
Registry record updated May 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PP414299L Issued in PA
Legal business name
CAMILLA HALL INFIRMARY
Practice address
100 Maxis Drive
Malvern, PA 19355
Phone
(484) 321-5656
Fax
(484) 321-5657
NPI assigned
Dec 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2022

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

Authorized official

Name
Carolyn M McWilliams, RPH
Title
Director of Pharmacy
Phone
(484) 321-5656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X PP414299L PA Primary

Addresses

Primary practice location

100 Maxis Drive
Malvern, PA 19355

Mailing address

100 Maxis Drive
Malvern, PA 19355
Phone (484) 321-5656

Other identifiers 2

IdentifierTypeStateIssuer
2079703OtherPK
1230524MedicaidPA

Other names 1

  • Camilla Hall Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201223000545 PA Part B Supplier - Mass Immunization (Roster Biller Only) 4981016599 Practice locations: Malvern, PA

National Provider Directory

National Provider Directory
Tax ID family
Camilla Hall Infirmary3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

100 Maxis Dr
Malvern, PA 19355
Phone (484) 321-5656

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1245396555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MAXIS DRIVE",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "19355",
            "telephone_number": "484-321-5656",
            "fax_number": "484-321-5657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAXIS DRIVE",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "19355",
            "telephone_number": "484-321-5656",
            "fax_number": "484-321-5657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMILLA HALL INFIRMARY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A",
        "authorized_official_last_name": "MCWILLIAMS",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "484-321-5656",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "PA",
            "license": "PP414299L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2079703",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1230524",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camilla Hall Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Malvern, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.