Individual
IN SUB HAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
4400 HAVERFORD AVE, PHILADELPHIA, PA 19104-1361
(215) 685-7626
Mailing address
500 S BROAD ST, PHILADELPHIA, PA 19146-1613
(215) 685-6864
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP030640L
PA
Other
Enumeration date
09/14/2006
Last updated
07/08/2007
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