Organization
BREWERYTOWN RX INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTICE E.K. HAGAN PHARMD (PHARMACY MANAGER)
(267) 773-8349
Entity
Organization
Contact information
Practice address
2621 W GIRARD AVE, PHILADELPHIA, PA 19130-1333
(267) 773-8349
Mailing address
2621 W GIRARD AVE, PHILADELPHIA, PA 19130-1333
(267) 773-8349
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP482063
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PP482063
PA PHARMACY PERMIT NUMBER
PA
Enumeration date
12/06/2010
Last updated
07/06/2017
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