Organization
SHADELAND PHARMACY LLC
Active
Other names
Shadeland Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MAHEN PATEL (MEMBER)
(267) 207-1114
Entity
Organization
Contact information
Practice address
403 SHADELAND AVE, DREXEL HILL, PA 19026-1437
(610) 622-1630
(610) 622-1647
Mailing address
403 SHADELAND AVE, DREXEL HILL, PA 19026-1437
(610) 622-1630
(610) 622-1647
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP482232
PA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143594
PK
—
Enumeration date
09/13/2011
Last updated
12/03/2014
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