Organization
WALNUT STREET APOTHECARY INC
Active
Other names
Wynnefield Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL SCOTA (OWNER)
(610) 247-4122
Entity
Organization
Contact information
Practice address
1901 N 54TH ST, PHILADELPHIA, PA 19131-3221
(215) 222-2400
(215) 222-2442
Mailing address
1006 W LEHIGH AVE, PHILADELPHIA, PA 19133-1640
(215) 225-7522
(215) 225-7525
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP482055
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3994274
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/20/2010
Last updated
07/08/2013
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