Organization
PENNCARE PHARMACY
Active
Organization
PENNCARE PHARMACY
Active
Other names
PENNCARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH K JIBI RPH (OWNER)
(615) 335-2760
Entity
Organization
Contact information
Practice address
416 OAK LN, PHILADELPHIA, PA 19126-3136
(215) 444-7525
Mailing address
4427 MASTER AVE, TREVOSE, PA 19053-6926
(215) 444-7525
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PP482935
STATE LICENSE
PA
Enumeration date
11/12/2019
Last updated
12/04/2019
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