Organization
BOOTHWYN PHARMACY LLC
Active
Other names
BOOTHWYN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS MICOLUCCI (OWNER)
(610) 485-1130
Entity
Organization
Contact information
Practice address
221 GALE LN, KENNETT SQUARE, PA 19348-1735
(800) 476-7496
(610) 497-4371
Mailing address
221 GALE LN, KENNETT SQUARE, PA 19348
(800) 476-7496
(610) 497-4371
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PP410228L
PA
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014804650002
—
PA
05
—
0936230001
—
NE
05
—
200887500A
—
IN
01
—
2082253
PK
—
05
—
7100087360
—
KY
05
—
7P228L
—
SC
Enumeration date
11/07/2006
Last updated
03/20/2017
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