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Provider Information for 1710221262


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SAN JUAN DE DIOS LLC

Organization Subpart: NO

NPI: 1710221262
Last Updated: 2012-11-30
Certification Date:

Details

NameValue
NPI1710221262
Enumeration Date2012-11-22
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: NEETA TRIPATHI
Title: PRESIDENT
Phone: 2672063861
Mailing Address 2122 GALLOWAY RD
BENSALEM, PA 19020-2988
United States

Phone: 267-206-3861 | Fax:
 
Primary Practice Address 961 N 10TH ST
READING, PA 19604-2353
United States

Phone: 610-743-4501 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyPAPP482330