Organization
BROAD AND GRANGE PHARMACY
Active
Other names
BROAD AND GRANGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN SNYDER (PRESIDENT)
(215) 228-9007
Entity
Organization
Contact information
Practice address
5751 N BROAD ST, PHILADELPHIA, PA 19141-2300
(215) 424-2611
(215) 424-6927
Mailing address
5751 N BROAD ST, PHILADELPHIA, PA 19141-2300
(215) 424-2611
(215) 424-6927
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481783
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2082477
PK
—
Enumeration date
02/08/2008
Last updated
06/13/2016
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