Organization
PHARMACY AT RIDGE & MIDVALE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOFI DEI GBOMITA PHARMD (OWNER/PRESIDENT/CEO)
(267) 664-2388
Entity
Organization
Contact information
Practice address
4219 RIDGE AVE, PHILADELPHIA, PA 19129-1745
(267) 385-6024
(267) 385-6238
Mailing address
4219 RIDGE AVE, PHILADELPHIA, PA 19129-1745
(267) 385-6024
(267) 385-6238
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP482271
PA
Other
Enumeration date
11/08/2012
Last updated
11/08/2012
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