CCN AMERICA LP (COORDINATED CARE NETWORK PHARMACY) - NPI NUMBER 1114004082

Summary

Provider Name: CCN AMERICA LP (COORDINATED CARE NETWORK PHARMACY)

NPI Number: 1114004082

Clasification: Pharmacy (333600000X)

Address:
300 PENN CENTER BLVD
STE 405
PITTSBURGH, PA
ZIP 15235

Phone Number: (412) 349-6337



Detailed Information

CCN AMERICA LP is a pharmacy in Pittsburgh, PA. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. The assigned NPI number for this provider is 1114004082 and is registered as an organization entity type.
The provider Is Doing Business As Coordinated Care Network Pharmacy.

The provider's business address is:

300 PENN CENTER BLVD
STE 405
PITTSBURGH, PA
ZIP 15235-511
Phone: (412) 349-6337
Fax: (412) 349-6311

The provider's authorized official is Thomas Pollack .
The authorized official title is Vp and has the following contact phone number (412) 349-6300.

The enumeration date for this NPI number is 10/31/2006 and was last updated on 5/21/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 333600000X Pharmacy No
2 332B00000X Durable Medical Equipment & Medical Supplies No
3 3336C0003X Pharmacy Community/Retail Pharmacy PP481123 PA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 0235504 MEDICAID NJ
2 5845900001 MEDICARE NSC
3 1018103020001 MEDICAID PA
4 7100147740 MEDICAID KY
5 2085919 OTHER PK
6 3810008615 MEDICAID WV
7 2721540 MEDICAID OH

NPI Record

No. Field Name Field Value
1 NPI 1114004082
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name CCN AMERICA LP
5 Provider Other Organization Name COORDINATED CARE NETWORK PHARMACY
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 300 PENN CENTER BLVD
8 Provider Second Line Business Practice Location Address STE 405
9 Provider Business Practice Location Address City Name PITTSBURGH
10 Provider Business Practice Location Address State Name PA
11 Provider Business Practice Location Address Postal Code 152355511
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 4123496337
14 Provider Business Practice Location Address Fax Number 4123496311
15 Provider Enumeration Date 10/31/2006
16 Last Update Date 5/21/2014
17 Authorized Official Last Name POLLACK
18 Authorized Official First Name THOMAS
19 Authorized Official Title or Position VP
20 Authorized Official Telephone Number 4123496300
21 Healthcare Provider Taxonomy Code 1 333600000X
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 332B00000X
24 Healthcare Provider Primary Taxonomy Switch 2 N
25 Healthcare Provider Taxonomy Code 3 3336C0003X
26 Provider License Number 3 PP481123
27 Provider License Number State Code 3 PA
28 Healthcare Provider Primary Taxonomy Switch 3 Y
29 Other Provider Identifier 1 0235504
30 Other Provider Identifier Type Code 1 05
31 Other Provider Identifier State 1 NJ
32 Other Provider Identifier 2 5845900001
33 Other Provider Identifier Type Code 2 07
34 Other Provider Identifier 3 1018103020001
35 Other Provider Identifier Type Code 3 05
36 Other Provider Identifier State 3 PA
37 Other Provider Identifier 4 7100147740
38 Other Provider Identifier Type Code 4 05
39 Other Provider Identifier State 4 KY
40 Other Provider Identifier 5 2085919
41 Other Provider Identifier Type Code 5 01
42 Other Provider Identifier Issuer 5 PK
43 Other Provider Identifier 6 3810008615
44 Other Provider Identifier Type Code 6 05
45 Other Provider Identifier State 6 WV
46 Other Provider Identifier 7 2721540
47 Other Provider Identifier Type Code 7 05
48 Other Provider Identifier State 7 OH
49 Is Organization Subpart N

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.