Philadelphia Professional Compounding Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP481799 Issued in PA

Legal business name

PHILADELPHIA PROFESSIONAL COMPOUNDING PHARMACY LLC

Practice address

23 S York Rd FRNT
Hatboro, PA 19040-3231

Phone

(215) 672-8552

Fax

(215) 672-8555

NPI assigned

May 22, 2008

Organization subpart

No

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

Authorized official

Name

Michael Cavanaugh, BS IN PHARMACY

Title

Partner

Phone

(215) 605-9211

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• PPC Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401235200000",
    "number": "1922265271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 S YORK RD FRNT",
            "city": "HATBORO",
            "state": "PA",
            "postal_code": "190403231",
            "telephone_number": "215-672-8552",
            "fax_number": "215-672-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 S YORK RD FRNT",
            "city": "HATBORO",
            "state": "PA",
            "postal_code": "190403231",
            "telephone_number": "215-672-8552",
            "fax_number": "215-672-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA PROFESSIONAL COMPOUNDING PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2014-05-28",
        "status": "A",
        "authorized_official_last_name": "CAVANAUGH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "215-605-9211",
        "authorized_official_credential": "BS IN PHARMACY"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP481799",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3990391",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PPC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bhavika Kantilal Patel, O.D.
• Eileen Cawley Paynton, CRNP
• Pennsylvania CVS Pharmacy LLC
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• Michael Petrowski, CRNA
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• Brad Robert Pieszala, D.M.D.
• Diane Plohocky
• Nancy J.M. Polin, MSN, CRNP
• Antonella Pontoriero, PSYD

• All providers in Hatboro, PA
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2014; 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.