Provider Demographics
NPI:1871913327
Name:AIDS CARE GROUP
Entity type:Organization
Organization Name:AIDS CARE GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-480-2501
Mailing Address - Street 1:1207B CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1332
Mailing Address - Country:US
Mailing Address - Phone:484-480-3341
Mailing Address - Fax:484-480-3344
Practice Address - Street 1:1207B CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1332
Practice Address - Country:US
Practice Address - Phone:484-480-3341
Practice Address - Fax:484-480-3344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIDS CARE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-23
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482215333600000X
3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102692301Medicaid
PA237360Medicare UPIN