1013470889 NPI number — CCN AMERICA LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013470889 NPI number — CCN AMERICA LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CCN AMERICA LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COORDINATED CARE NETWORK PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013470889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 PENN CENTER BLVD STE 505
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15235-5505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-349-6300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N CAMERON ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17101-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-614-8800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
POLLACK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CFO
Authorized Official Telephone Number:
412-349-6300

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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