Provider Demographics
NPI:1154753622
Name:CITIMED PHARMACY LLC
Entity type:Organization
Organization Name:CITIMED PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOMER-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-290-6840
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-0662
Mailing Address - Country:US
Mailing Address - Phone:215-224-7100
Mailing Address - Fax:215-224-7102
Practice Address - Street 1:7606 OGONTZ AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1817
Practice Address - Country:US
Practice Address - Phone:215-224-7100
Practice Address - Fax:215-224-7102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOGAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-06
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty