Provider Demographics
NPI:1124429725
Name:ESSINGTON PHARMACY LLC
Entity type:Organization
Organization Name:ESSINGTON PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-773-6082
Mailing Address - Street 1:50 W POWHATTAN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:ESSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19029-1220
Mailing Address - Country:US
Mailing Address - Phone:267-773-6082
Mailing Address - Fax:610-537-7652
Practice Address - Street 1:50 W POWHATTAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:ESSINGTON
Practice Address - State:PA
Practice Address - Zip Code:19029-1220
Practice Address - Country:US
Practice Address - Phone:267-773-6082
Practice Address - Fax:610-537-7652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 333600000X, 3336C0003X
PAPP4825023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147947OtherPK