Penncare Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PENNCARE PHARMACY

Doing business as

Penncare Pharmacy

Practice address

416 Oak LN
Philadelphia, PA 19126-3136

Phone

(215) 444-7525

NPI assigned

Nov 12, 2019

Last updated

Dec 4, 2019By 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

Joseph K Jibi, RPHNPI 1881800381

Title

Owner

Phone

(615) 335-2760

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PENNCARE PHARMACY Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph Kochadathil Jibi

  • Pharmacist
  • Philadelphia, PA
  • NPI 1881800381
  NPD Authorized official

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

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575417600000",
    "number": "1891330031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4427 MASTER AVE",
            "city": "TREVOSE",
            "state": "PA",
            "postal_code": "190536926",
            "telephone_number": "215-444-7525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 OAK LN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191263136",
            "telephone_number": "215-444-7525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNCARE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2019-12-04",
        "status": "A",
        "authorized_official_last_name": "JIBI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-335-2760",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PP482935",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "penncarepharmacy@yahoo.com",
            "affiliation": "N",
            "endpointDescription": "E-MAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "416 Oak Ln",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191263136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "PENNCARE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PENNCARE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Infinity Pennington
• Jessica Elizabeth Pennington, MD
• Kiersten Marie Pennington, LCSW

• Community/Retail Pharmacy in Philadelphia, PA
• Providers in Philadelphia, 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 Dec 4, 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.