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General NPI Number Information
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NPI Number | 1407088156
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Entity Type | Organization
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Legal Business Name | MEDARBOR LLC
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | 200 RITTENHOUSE CIR BLDG SUITEE3
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City | BRISTOL
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State | PA
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Zip | 19007-1619
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Country | US
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Telephone | 610-660-8100
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Fax | 866-740-4689
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Provider Business Mailing Address
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Address Line | 200 RITTENHOUSE CIR STE 3E
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City | BRISTOL
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State | PA
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Zip | 19007-1625
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Country | US
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Telephone | 610-660-8100
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Fax | 866-740-4689
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIROSLAV KESIC
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Credential | PHARM.D.
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Telephone | 610-660-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP481966
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License Number State | PA
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