Organization
PENNSCARERX PHARMA INC
Active
Other names
PENNSCARE FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. YADAGIRI PENDYALA (PHARMACIST-IN-CHARGE)
(917) 972-3340
Entity
Organization
Contact information
Practice address
182 N BROADWAY, PENNSVILLE, NJ 08070-1419
(856) 514-2638
(856) 514-2678
Mailing address
182 N BROADWAY, PENNSVILLE, NJ 08070-1419
(856) 514-2638
(856) 514-2678
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00720400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0383929
—
NJ
01
—
2136131
PK
—
Enumeration date
06/29/2012
Last updated
08/27/2016
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