Healthcare Provider Details

I. General information

NPI: 1023153053
Provider Name (Legal Business Name): THE PENNSYLVANIA HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

800 SPRUCE ST
PHILADELPHIA PA
19107-6130
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-5873
  • Fax:
Mailing address:
  • Phone: 215-829-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP415759L
License Number StatePA

VIII. Authorized Official

Name: MR. THOMAS M MCCORMICK JR.
Title or Position: ASSOC VICE PRES FINANCE
Credential:
Phone: 215-796-4640