Organization
FAIRMOUNT PHARMACY INC
Active
Other names
FAIRMOUNT PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
GERARD VOLGRAF RPH (PHARMACIST MANAGER AND VP)
(215) 567-0364
Entity
Organization
Contact information
Practice address
1900 GREEN ST, PHILADELPHIA, PA 19130-3207
(215) 567-0364
(215) 567-1931
Mailing address
1900 GREEN ST, PHILADELPHIA, PA 19130-3207
(215) 567-0364
(215) 567-1931
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP411438L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011124960001
—
PA
01
—
2086440
PK
—
Enumeration date
07/12/2005
Last updated
02/23/2015
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