Organization
DAVIDEJA LLC
Active
Parent organization
DAVIDEJA, LLC
Other names
Your Drug Store
Organization subpart
Yes
Provider details
NPI number
Legal business name
DAVIDEJA, LLC
Authorized official
MR. DAVID SIMMONS R.PH (PHARMACIST-IN-CHARGE)
(267) 325-0139
Entity
Organization
Contact information
Practice address
249 S 52ND ST, PHILADELPHIA, PA 19139-4148
(215) 748-0800
(215) 748-1269
Mailing address
249 S. 52ND STREET, PHILADELPHIA, PA 19139-9999
(215) 748-0800
(215) 748-1269
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481376
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101034939-0001
—
PA
01
—
3983447
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/20/2006
Last updated
10/04/2012
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