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Organization

KINGDOM PHARMACY LLC

Active
Other names
Kingdom Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
MARTINE KOUAHOU (MANAGER)
(484) 455-7915
Entity
Organization

Contact information

Practice address
9014 W CHESTER PIKE, UPPER DARBY, PA 19082-2606
(484) 455-7915
(484) 455-7923
Mailing address
9014 W CHESTER PIKE, UPPER DARBY, PA 19082-2606
(484) 455-7915
(484) 455-7923

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP482480
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1029193710001
PA
01
2145885
PK
Enumeration date
05/21/2014
Last updated
11/29/2016
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