Healthcare Provider Details

I. General information

NPI: 1407796352
Provider Name (Legal Business Name): CORECOMP RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 LINCOLN AVE STE B3
HATBORO PA
19040-2243
US

IV. Provider business mailing address

390 LINCOLN AVE STE B3
HATBORO PA
19040-2243
US

V. Phone/Fax

Practice location:
  • Phone: 445-300-7010
  • Fax: 445-300-7060
Mailing address:
  • Phone: 445-300-7010
  • Fax: 445-300-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: OMAR ELMEDANI
Title or Position: OWNER
Credential:
Phone: 609-384-4560