Organization
PENNSPORT MALL PHARMACY LLC
Active
Other names
Pennsport Mall Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GINO CUFFARI (MANAGER/OWNER)
(267) 340-7534
Entity
Organization
Contact information
Practice address
237 MCCLELLAN ST, PHILADELPHIA, PA 19148-1954
(267) 639-4657
(267) 687-2583
Mailing address
237 MCCLELLAN ST, PHILADELPHIA, PA 19148
(267) 639-4657
(267) 687-2583
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP482611
PA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030762100001
—
PA
01
—
2155869
PK
—
Enumeration date
12/08/2015
Last updated
09/19/2025
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