Healthcare Provider Details

I. General information

NPI: 1275591166
Provider Name (Legal Business Name): RTA PHARMACY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 EAST 10TH STREET
MARCUS HOOK PA
19061
US

IV. Provider business mailing address

255 WILMINGTON WEST CHESTER PIKE SUITE 4
CHADDS FORD PA
19317
US

V. Phone/Fax

Practice location:
  • Phone: 484-816-3997
  • Fax: 484-816-3998
Mailing address:
  • Phone: 610-558-6222
  • Fax: 610-558-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPP415331L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP415331L
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPP415331L
License Number StatePA
# 8
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP415331L
License Number StatePA

VIII. Authorized Official

Name: MR. CHARLES M. CICCONE
Title or Position: PRESIDENT
Credential: CRT.
Phone: 610-558-6222