Healthcare Provider Details

I. General information

NPI: 1164844098
Provider Name (Legal Business Name): CCN AMERICA LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 DR MARTIN LUTHER KING JR BLVD
NEWARK NJ
07102-2011
US

IV. Provider business mailing address

300 PENN CENTER BLVD STE 505
PITTSBURGH PA
15235-5505
US

V. Phone/Fax

Practice location:
  • Phone: 862-237-7298
  • Fax:
Mailing address:
  • Phone: 412-349-6300
  • Fax: 412-349-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00730700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS POLLACK
Title or Position: VICE PRESIDENT AND CFO
Credential:
Phone: 412-349-6300