National Provider Identifier Database

BOOTHWYN PHARMACY LLC
Compounding Pharmacy

A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner?s Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice.


Contact Information

BOOTHWYN PHARMACY LLC
221 GALE LN
KENNETT SQUARE, PA19348-1735
Phone: 800-476-7496
Fax: 610-497-4371
Website:
Specialty Taxonomy Code
* Compounding Pharmacy 3336C0004X
Community/Retail Pharmacy 3336C0003X
Durable Medical Equipment & Medical Supplies 332B00000X
Home Infusion Therapy Pharmacy 3336H0001X
Long Term Care Pharmacy 3336L0003X
Pharmacy 333600000X
Specialty Pharmacy 3336S0011X

* Indicates primary specialty

NPI Profile & details for BOOTHWYN PHARMACY LLC

NPI Number 1861561714
Legal business name
LBN
BOOTHWYN PHARMACY LLC
Authorized official LOUIS MICOLUCCI - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 11/07/2006
Last updated 03/20/2017 - About 9 years ago
Sole proprietor1 Not specified
Identifiers
  • PA License #: PP410228L
  • IN Medicaid: 200887500A
  • KY Medicaid: 7100087360
  • NE Medicaid: 0936230001
  • PA Medicaid: 0014804650002
  • SC Medicaid: 7P228L
  • Other: 2082253 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for BOOTHWYN PHARMACY LLC

There are currently no reviews for BOOTHWYN PHARMACY LLC


NPIdb - Home
v2.201