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SUBURBAN BUSTLETON PHARMACY INC.
NPI 1962560565
Pharmacy - Community/Retail Pharmacy in Philadelphia, PA

Active since December 05, 2006CLIA 39D2206967 · Waiver
10875 BUSTLETON AVENUE, PHILADELPHIA, PA 19116(215) 673-0994(215) 969-6176 Get Directions Write a Review

NPPES record last updated: January 21, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 21, 2026, Apr 27, 2022, Jan 27, 2016 (3 updates tracked since 2016).

About Suburban Bustleton Pharmacy Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUBURBAN BUSTLETON PHARMACY INC. (NPI 1962560565), doing business as Suburban Pharmacy, is a healthcare organization registered as a community/retail pharmacy in Philadelphia, Pennsylvania and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through December 22, 2026 and lists Jane Dzierza, Owner, as its authorized official.

NPPES Registry Identity

NPI1962560565
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSUBURBAN BUSTLETON PHARMACY INC.
Location Address10875 BUSTLETON AVENUEPhiladelphia, PA 19116-3301
Mailing Address10875 Bustleton AvePhiladelphia, PA 19116-3301 · (215) 673-0994 · Fax (215) 969-6176
Phone(215) 673-0994
Fax(215) 969-6176
Organization SubpartNo
Authorized OfficialJane DzierzaOwner · (215) 673-0994
Enumeration DateDecember 5, 2006
Last NPPES UpdateJanuary 21, 20263 updates tracked since enumeration
NPPES CertifiedJanuary 21, 2026
✔ NPI 1962560565 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in PA · PP412433L
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
10875 BUSTLETON AVENUE, Philadelphia, PA 19116
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Other Names 1

Doing Business AsSuburban Pharmacy

Other Identifiers 1

Medicaid0014348470001PA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arkansas Health & Wellness and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Suburban Bustleton Pharmacy Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StatePennsylvaniaEnrollment IDO20120103000222Non-DME Part B · Mass Immunization (Roster Biller Only)Due dateDecember 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D2206967

Suburban Bustleton Pharmacy Dba Suburbans Pharmacy · Phila, PA
Active · expires Dec 22, 2026
CLIA Number39D2206967
Laboratory TypePharmacy
Certificate Effective DateDecember 23, 2024
Certificate Expiration DateDecember 22, 2026
Laboratory DirectorLenny Fox
Laboratory Phone(215) 673-0994
Laboratory LocationSuburban Bustleton Pharmacy Dba Suburbans Pharmacy10875 Bustleton Ave, Phila, PA 19116
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
29 services29 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
27 services27 patients

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Suburban Bustleton Pharmacy Inc.'s NPI number?

The NPI number for Suburban Bustleton Pharmacy Inc. is 1962560565. It was assigned to this organization in the NPPES registry on December 5, 2006. The provider is doing business as Suburban Pharmacy.

Where is Suburban Bustleton Pharmacy Inc. located?

Suburban Bustleton Pharmacy Inc. is located at 10875 Bustleton Avenue, Philadelphia, PA 19116. The listed phone number is (215) 673-0994.

What is Suburban Bustleton Pharmacy Inc.'s specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Is Suburban Bustleton Pharmacy Inc. enrolled in Medicare?

Yes. Suburban Bustleton Pharmacy Inc. is registered in the Medicare PECOS enrollment system.

When is Suburban Bustleton Pharmacy Inc.'s Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Pennsylvania, Mass Immunization (Roster Biller Only)) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Suburban Bustleton Pharmacy Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D2206967) is associated with this NPI, valid through December 22, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Suburban Bustleton Pharmacy Inc. accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arkansas Health & Wellness and 44 other insurers list Suburban Bustleton Pharmacy Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Suburban Bustleton Pharmacy Inc. was last updated on January 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.