MEDICARE: CHRISTIAN ST PHARMACY

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	PP412075L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3948203	OTHER	PA	NABP

General Provider Information

NPI Number	:	1558587030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN ST PHARMACY

Provider Business Mailing Address
First Line	:	1947 CHRISTIAN STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146
Country	:	US
Telephone Number	:	215-545-3582
Fax Number	:	215-545-3583

Provider Business Practice Location Address
First Line	:	1947 CHRISTIAN STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146
Country	:	US
Telephone Number	:	215-545-3582
Fax Number	:	215-545-3583

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. JEROME P WHACK
Credential	:	RPH
Telephone Number	:	215-545-3582

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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Directions to “CHRISTIAN ST PHARMACY ” Practice Location

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