MEDICARE: PENNSBURY PHARMACY 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	3336C0003X	Community/Retail Pharmacy	PP482497	PA

General Provider Information

NPI Number	:	1386053627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNSBURY PHARMACY INC.

Provider Business Mailing Address
First Line	:	8545 NEW FALLS RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19054-1601
Country	:	US
Telephone Number	:	215-547-2378
Fax Number	:

Provider Business Practice Location Address
First Line	:	8545 NEW FALLS RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19054-1601
Country	:	US
Telephone Number	:	215-547-2378
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY OWNER, MANAGER
Name	:	KENNETH LEE
Credential	:	PHARMACIST
Telephone Number	:	215-260-8708

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	08/25/2014

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