Crest Center Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP481086 Issued in PA

Legal business name

CREST CENTER PHARMACY

Practice address

240 Fitzwatertown Rd
Willow Grove, PA 19090-2332

Phone

(215) 658-1216

Fax

(610) 658-1217

NPI assigned

Aug 9, 2005

Last updated

Nov 13, 2007By 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

David Mittal

Title

Owner

Phone

(215) 915-6075

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1851392179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 FITZWATERTOWN RD",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190902332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 FITZWATERTOWN RD",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190902332",
            "telephone_number": "215-658-1216",
            "fax_number": "610-658-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREST CENTER PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "MITTAL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-915-6075"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP481086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007428070002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3979703",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Conoscenti, PT
• Marianna Cooper-Drew
• Courage Compass Therapy
• Tametria Cox
• Matthew R Craig, M.D., M.S.
• Sarah D Creswell
• Brian Colum Cronin, MD
• Michael Joseph Cubbin, RPH
• Angela Marie Curry, PSY.D
• Diane Custer

• Community/Retail Pharmacy in Willow Grove, PA
• Providers in Willow Grove, 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 Nov 13, 2007; 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.