Organization
GOODWILL COMMUNITY PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
UCHE DAVIS (OWNER)
(267) 385-5458
Entity
Organization
Contact information
Practice address
5002 WAYNE AVE, PHILADELPHIA, PA 19144-3642
(267) 385-5554
(267) 385-5485
Mailing address
5002 WAYNE AVE, PHILADELPHIA, PA 19144-3642
(267) 385-5554
(267) 385-5485
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP482421
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029378990001
—
PA
Enumeration date
02/19/2014
Last updated
04/01/2020
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