Organization
ADEYINKA T ADEBAMIRO
Active
Other names
ATA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ADEYINKA ADEBAMIRO (OWNER)
(215) 424-1966
Entity
Organization
Contact information
Practice address
5915 N BROAD ST, PHILADELPHIA, PA 19141-1801
(215) 424-1966
(215) 549-2499
Mailing address
5915 N BROAD ST, PHILADELPHIA, PA 19141-1801
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481770
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3989627
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/02/2008
Last updated
04/10/2009
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