Philadelphia Department of Public Health Center Pharmacy #1
Organization Active NPI Clinic Pharmacy · Philadelphia, PA
NPI 1780752188 · NPPES record last updated Mar 7, 2019
Key facts
- NPI
- 1780752188
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic Pharmacy 3336C0002X
- License
- PP481593 (PA)
- Legal business name
- PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH CENTER PHARMACY #1
- Practice address
- 500 S. Broad Street
Pharmacy
Philadelphia, PA 19146 - Phone
- (215) 685-6513
- Fax
- (215) 790-1651
- NPI assigned
- Dec 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeffrey T. Pender, RPH
- Title
- Director of Pharmaceutical Services
- Phone
- (215) 685-6864
Corporate family (same tax ID) 22
National Provider Directory
- Tax ID family
- Health Center 2
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic Pharmacy | 3336C0002X | PP481593 | PA | Yes |
| Institutional Pharmacy | 3336I0012X | |||
| Institutional Pharmacy | 3336I0012X | PA |
Addresses
Primary practice location
500 S. Broad Street
Pharmacy
Philadelphia, PA 19146
Mailing address
500 S. Broad Street
Pharmacy/Basement
Philadelphia, PA 19146
Phone (215) 685-6864
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2081751 | Other | PK | |
| 1000076950093 | Medicaid | PA |
Other names
- HEALTH CENTER #1 PHARMACY
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All providers in Philadelphia, PA · Clinic Pharmacy in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.