Organization
FASTVAX LLC
Active
Other names
Fastvax Pharmacy and Vaccine Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMBER THOMPSON (GENERAL MANAGER)
(215) 996-1400
Entity
Organization
Contact information
Practice address
829 SPRUCE STREET, PHILADELPHIA, PA 19107-5752
(215) 923-7070
(215) 923-0489
Mailing address
829 SPRUCE STREET, PHILADELPHIA, PA 19107-5752
(215) 923-7070
(215) 923-0489
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PP413108L
PA
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
PP413108L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3921613
NCPDP
PA
01
—
3921613
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/25/2005
Last updated
02/16/2011
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