Organization
WALTER CWIETNIEWICZ
Active
Other names
ELLIS PRESCRIPTION PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER CWIETNIEWICZ BS (RPH/PROP)
(215) 765-1903
Entity
Organization
Contact information
Practice address
2441 BROWN ST, PHILADELPHIA, PA 19130-1931
(215) 765-1903
(215) 236-6606
Mailing address
2441 BROWN ST, PHILADELPHIA, PA 19130-1931
(215) 765-1903
(215) 236-6606
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP410688L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1157371
—
PA
01
—
2086924
PK
—
Enumeration date
04/05/2006
Last updated
03/01/2017
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