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Organization
NINTH STREET PHARMACY
Active
Organization
NINTH STREET PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. YURI SOROCHKIN (SUPERVISING PHARMACIST)
(215) 468-0497
Entity
Organization
Contact information
Practice address
2400 S 9TH ST, PHILADELPHIA, PA 19148-3716
(215) 468-0497
Mailing address
1256 SEROTA DR, PHILADELPHIA, PA 19115-2526
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PP412224L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016918740001
—
PA
01
—
3983966
NCPDP NUMBER
PA
01
—
PP412224L
STATE LICENSE NUMBER
PA
Enumeration date
11/09/2006
Last updated
03/07/2023
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