NPIMap

Organization Active NPI

Philadelphia Department of Public Health Center Pharmacy #10

Doing business as Pharmacy Health Center #10

  • Clinic Pharmacy
  • Philadelphia, PA
National Provider Identifier
1417038191
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 #10
Doing business as
Pharmacy Health Center #10
Practice address
2230 Cottman Avenue
Philadelphia, PA 19149
Phone
(215) 685-0616
NPI assigned
Oct 18, 2006
Last updated
Mar 7, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
PHILADELPHIA DEPARTMENT OF PUBLIC HEALTHAs reported in NPPES

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X HP418337L PA
Federally Qualified Health Center (FQHC) 261QF0400X PA
Clinic Pharmacy 3336C0002X Primary

Addresses

Primary practice location

2230 Cottman Avenue
Philadelphia, PA 19149

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1000076950045MedicaidPA

Other names 1

  • Pharmacy Health Center #10 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Phila HLTH Ctr No 523 organizations share this tax ID, including this one
Part of
Phila HLTH Ctr No 5

Other organizations with this tax ID 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551916800000",
    "number": "1417038191",
    "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": "2230 COTTMAN AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19149",
            "telephone_number": "215-685-0616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH CENTER PHARMACY #10",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH",
        "enumeration_date": "2006-10-18",
        "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": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": "HP418337L",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000076950045",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmacy Health Center #10",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pharmacy Health Center #10",
            "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.