MEDICARE: NORTH WALES FAMILY 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	PP482630	PA

General Provider Information

NPI Number	:	1487016473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH WALES FAMILY PHARMACY, INC

Provider Business Mailing Address
First Line	:	107 S MAIN ST
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 S MAIN ST
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2832
Country	:	US
Telephone Number	:	215-699-6949
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	NAZAR UGHRYN
Credential	:
Telephone Number	:	215-475-7700

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/28/2016

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