Organization
HILLRISE PHARMACY LLC
Active
Other names
HillRise Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
OMOTAYO BADEJOKO B PHARM (MEMBER/OWNER)
(484) 326-1877
Entity
Organization
Contact information
Practice address
4240 N BROAD ST UNIT B, PHILADELPHIA, PA 19140-1908
(215) 403-7300
(267) 335-3937
Mailing address
4240 N BROAD ST UNIT B, PHILADELPHIA, PA 19140-1908
(215) 403-7300
(267) 335-3937
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP482646
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1031140170001
—
PA
01
—
2160216
PK
—
Enumeration date
05/23/2016
Last updated
07/27/2018
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