NPIMap

Organization Active NPI

Presbyterian Medical Center of the University of Pennsylvania Health S

Doing business as Penn-Presbyterian Med Ctr Pharmacy

  • Pharmacy
  • Philadelphia, PA
National Provider Identifier
1265518682
Registry record updated Jul 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PP481327 Issued in PA
Legal business name
PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S
Doing business as
Penn-Presbyterian Med Ctr Pharmacy
Practice address
51 N 39TH Street, Medical Office BLDG
Philadelphia, PA 19104
Phone
(215) 662-9494
Fax
(215) 243-4681
NPI assigned
Oct 27, 2006
Last updated
Jul 2, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 2, 2019

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

Authorized official

Name
Mr. Robert John Russell Jr.
Title
Associate Executive Director
Phone
(215) 662-9108

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X PP481327 PA
Pharmacy 333600000X PP481327 PA Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

51 N 39TH Street, Medical Office BLDG
Philadelphia, PA 19104

Mailing address

39TH & Market Streets
Department of Pharmacy
Phila, PA 19104-2640
Phone (215) 662-9494

Other identifiers 1

IdentifierTypeStateIssuer
1007297070028MedicaidPA

Other names 1

  • Penn-Presbyterian Med Ctr Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190729001197 PA Part B Supplier - Pharmacy 0042115008 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Uphs Presbyterian Medic15 organizations share this tax ID, including this one
Part of
Uphs Presbyterian Medic

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1265518682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39TH & MARKET STREETS",
            "address_2": "DEPARTMENT OF PHARMACY",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191042640",
            "telephone_number": "215-662-9494",
            "fax_number": "215-243-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N 39TH STREET, MEDICAL OFFICE BLDG",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-9494",
            "fax_number": "215-243-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S",
        "enumeration_date": "2006-10-27",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "ASSOCIATE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "215-662-9108",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "PA",
            "license": "PP481327",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP481327",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007297070028",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penn-Presbyterian Med Ctr 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 Jul 2, 2019; 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.