Healthcare Provider Details

I. General information

NPI: 1043578826
Provider Name (Legal Business Name): SPRINGFIELD PHARMACEUTICALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 BALTIMORE PIKE
SPRINGFIELD PA
19064-2850
US

IV. Provider business mailing address

1154 BALTIMORE PIKE
SPRINGFIELD PA
19064-2850
US

V. Phone/Fax

Practice location:
  • Phone: 610-544-4645
  • Fax: 610-544-1757
Mailing address:
  • Phone: 610-544-4645
  • Fax: 610-544-1757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482265
License Number StatePA

VIII. Authorized Official

Name: CHIMDIMMA ILONZO
Title or Position: MANAGING PARTNER
Credential:
Phone: 610-544-4645