Organization
PHILLY PHARMACY II, LLC
Active
Other names
Philly Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD GARCIA (PHARMACY MANAGER)
(215) 969-5180
Entity
Organization
Contact information
Practice address
9475 ROOSEVELT BLVD STE 12, PHILADELPHIA, PA 19114-2212
(215) 625-6668
(866) 379-3198
Mailing address
9475 ROOSEVELT BLVD, STE 12, PHILADELPHIA, PA 19114-2212
(215) 625-6668
(866) 379-3198
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP482144
PA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3995480
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/20/2011
Last updated
05/20/2011
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