MEDICARE: MEDARBOR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP481966	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2121939	OTHER		PK

General Provider Information

NPI Number	:	1407088156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDARBOR LLC

Provider Business Mailing Address
First Line	:	200 RITTENHOUSE CIR STE 3E
Second Line	:
City	:	BRISTOL
State	:	PA
Zip	:	19007-1625
Country	:	US
Telephone Number	:	610-660-8100
Fax Number	:	866-740-4689

Provider Business Practice Location Address
First Line	:	200 RITTENHOUSE CIR BLDG SUITEE3
Second Line	:
City	:	BRISTOL
State	:	PA
Zip	:	19007-1619
Country	:	US
Telephone Number	:	610-660-8100
Fax Number	:	866-740-4689

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIROSLAV KESIC
Credential	:	PHARM.D.
Telephone Number	:	610-660-8100

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	01/22/2018

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Directions to “MEDARBOR LLC ” Practice Location

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