Organization
HENNEBERRY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES HENNEBERRY (OWNER)
(215) 765-1033
Entity
Organization
Contact information
Practice address
838 N 24TH ST, PHILADELPHIA, PA 19130-1914
(215) 765-1033
Mailing address
838 N 24TH ST, PHILADELPHIA, PA 19130-1914
(215) 765-1033
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP410745L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005770300001
—
PA
Enumeration date
08/29/2006
Last updated
08/22/2020
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