Healthcare Provider Details

I. General information

NPI: 1922029982
Provider Name (Legal Business Name): TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 KING OF PRUSSIA RD STE 109N
RADNOR PA
19087-4557
US

IV. Provider business mailing address

145 KING OF PRUSSIA RD STE 109N
RADNOR PA
19087-4557
US

V. Phone/Fax

Practice location:
  • Phone: 610-902-1700
  • Fax: 610-902-1704
Mailing address:
  • Phone: 610-902-1700
  • Fax: 610-902-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481406
License Number StatePA

VIII. Authorized Official

Name: RICHARD FIORE
Title or Position: PHCY MGR
Credential: RPH
Phone: 610-902-1700