Basic Information
| Provider Information | |||||||||
| NPI: | 1689787111 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ENCLARA PHARMACIA, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EXCELLERX | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 CHERRY ST | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152821600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 512 ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | SHARON HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190791014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4849531800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | VALENTINE | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7329961187 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | PP481494 | PA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 3336C0003X | PP481494 | PA | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336L0003X | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
No ID Information.