Organization
BROAD STREET FAMILY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH THOMPSON (PRESIDENT)
(215) 755-2010
Entity
Organization
Contact information
Practice address
1416 S BROAD ST, PHILADELPHIA, PA 19146-4861
(215) 755-2010
Mailing address
1416 S BROAD ST, PHILADELPHIA, PA 19146-4861
(215) 755-2010
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PP4811922
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PP481922
—
PA
Enumeration date
08/05/2009
Last updated
11/03/2011
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