MEDICARE: COTTMAN 1 PHARMACY 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
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1184186470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTMAN 1 PHARMACY LLC

Provider Business Mailing Address
First Line	:	1701 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3802
Country	:	US
Telephone Number	:	215-728-6300
Fax Number	:	215-728-6302

Provider Business Practice Location Address
First Line	:	1701 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3802
Country	:	US
Telephone Number	:	215-728-6300
Fax Number	:	215-728-6302

Authorized Official
Title or Position	:	MEMBER OF LLC
Name	:	NIKITA PATEL
Credential	:
Telephone Number	:	215-728-6300

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	04/04/2019

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