Provider Demographics
NPI:1053381749
Name:FRIENDLY PHARMACY, L.P.
Entity type:Organization
Organization Name:FRIENDLY PHARMACY, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:POLICARE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-425-5230
Mailing Address - Street 1:2258 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-3714
Mailing Address - Country:US
Mailing Address - Phone:215-425-5230
Mailing Address - Fax:
Practice Address - Street 1:2258 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3714
Practice Address - Country:US
Practice Address - Phone:215-425-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3963166OtherNCPDP
PAPP414506LOtherPHARMACY PERMIT
PA1007474100003Medicaid
PA1007474100003Medicaid
PABF2930988OtherDEA
PA1007474100003Medicaid