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NPI Code Detail

MEDICARE: FKATAN LLC

MEDICARE: FKATAN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacyPP482650PA
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104274406
Entity Type Code : Organization
Provider Name (Legal Business Name) : FKATAN LLC
Provider Business Mailing Address
First Line : 1607 S KEYSTONE AVE
Second Line :
City : UPPER DARBY
State : PA
Zip : 19082-3514
Country : US
Telephone Number : 215-473-0750
Fax Number : 215-473-1804
Provider Business Practice Location Address
First Line : 5927 LANSDOWNE AVE FL 1
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19151-3932
Country : US
Telephone Number : 215-473-0750
Fax Number : 215-473-1804
Authorized Official
Title or Position : PHARMACY MANAGER
Name : DR. AYALEW TASSEW
Credential : PHARMD
Telephone Number : 202-365-5070
Provider Enumeration Date : 05/26/2016
Last Update Date : 06/04/2025

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Directions to “FKATAN LLC ” Practice Location

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