Provider Demographics
NPI:1487657839
Name:TEL-DRUG OF PENNSYLVANIA, L.L.C.
Entity type:Organization
Organization Name:TEL-DRUG OF PENNSYLVANIA, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DESSENDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-706-5124
Mailing Address - Street 1:206 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2208
Mailing Address - Country:US
Mailing Address - Phone:215-706-5124
Mailing Address - Fax:800-973-7150
Practice Address - Street 1:206 WELSH RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2208
Practice Address - Country:US
Practice Address - Phone:215-706-5124
Practice Address - Fax:800-973-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415582L3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4813790001Medicare NSC