Provider Demographics
NPI:1578361168
Name:PENN SPECIALTY PHARMACY LLC
Entity type:Organization
Organization Name:PENN SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:Y
Authorized Official - Middle Name:
Authorized Official - Last Name:A
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-238-9818
Mailing Address - Street 1:161 W TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2519
Mailing Address - Country:US
Mailing Address - Phone:201-238-9818
Mailing Address - Fax:
Practice Address - Street 1:161 W TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-2519
Practice Address - Country:US
Practice Address - Phone:201-238-9818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy