MEDICARE: UNITED PHARMACY UPPERDARBY INC

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PP481752	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3989033	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134313588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED PHARMACY UPPERDARBY INC

Provider Business Mailing Address
First Line	:	206B W CHELTEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3803
Country	:	US
Telephone Number	:	215-438-3880
Fax Number	:	215-438-3883

Provider Business Practice Location Address
First Line	:	206B W CHELTEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3803
Country	:	US
Telephone Number	:	215-438-3880
Fax Number	:	215-438-3883

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICTORIA OBASI
Credential	:
Telephone Number	:	215-438-3880

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	01/14/2011

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