Organization
JA COBEX, LLC
Active
Other names
Philly Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TAM ONIATE (MANAGER)
(215) 969-5180
Entity
Organization
Contact information
Practice address
1900 GRANT AVE STE F, PHILADELPHIA, PA 19115-4370
(215) 969-5180
(866) 379-3198
Mailing address
1900 GRANT AVE STE F, PHILADELPHIA, PA 19115-4370
(215) 969-5180
(866) 379-3198
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP482144
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028047850002
—
PA
01
—
2138971
PK
—
Enumeration date
02/01/2013
Last updated
04/19/2017
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