Organization
OAK LANE PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUANITA VIVIAN RATHFON (PHARMACY MANAGER)
(215) 924-9929
Entity
Organization
Contact information
Practice address
6724 OLD YORK RD, PHILA, PA 19126-2840
(215) 924-9929
Mailing address
6724 OLD YORK RD, PHILA, PA 19126-2840
(215) 924-9929
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481792
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021085070001
—
PA
Enumeration date
08/27/2008
Last updated
08/27/2008
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