Organization
INDEPENDENT RX INCORPORATED
Active
Other names
Centennial Pharmacy-Queen Village
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH DYMOWSKI (PRESIDENT/OWNER)
(267) 324-5347
Entity
Organization
Contact information
Practice address
843 S 2ND ST STE 2, PHILADELPHIA, PA 19147-3445
(267) 324-5347
(267) 324-5418
Mailing address
2660 LEFEVRE ST, PHILADELPHIA, PA 19137-2044
(215) 535-4111
(215) 535-4115
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP482369
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102466113002
—
PA
01
—
2138507
PK
—
Enumeration date
05/16/2013
Last updated
11/23/2015
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