MEDICARE: TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1821760604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA

Provider Business Mailing Address
First Line	:	3400 SPRUCE ST
Second Line	:	GROUND RHODES
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CONVENTION AVE STE 1323
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4311
Country	:	US
Telephone Number	:	267-862-1600
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	GENEVIEVE LEVANS
Credential	:
Telephone Number	:	215-796-2085

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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Directions to “TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA ” Practice Location

Language	Start Address	Practice Location

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