Organization
DEDICATED PENNSYLVANIA HOLDING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY CHEN (AUTHORIZED OFFICIAL)
(305) 831-4722
Entity
Organization
Contact information
Practice address
5675 N. FRONT STRREET, SUITE 141, PHILADELPHIA, PA 19120-1910
(305) 628-6117
(305) 363-5989
Mailing address
1395 NW 167TH ST, MIAMI GARDENS, FL 33169-5710
(305) 628-6117
(305) 363-5989
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Enumeration date
01/19/2018
Last updated
10/31/2024
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