Healthcare Provider Details

I. General information

NPI: 1902815913
Provider Name (Legal Business Name): TERRAPIN WEST END PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 HORIZON BLVD STE 103B
TREVOSE PA
19053-4968
US

IV. Provider business mailing address

3800 HORIZON BLVD STE 103B
TREVOSE PA
19053-4968
US

V. Phone/Fax

Practice location:
  • Phone: 610-433-1826
  • Fax: 610-433-0386
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP-412851-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GREG GANSE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 443-837-0200