MEDICARE: R J JOMICI 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP412527L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2083090	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568560597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R J JOMICI INC

Provider Business Mailing Address
First Line	:	273 S 15TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-5060
Country	:	US
Telephone Number	:	215-735-6337
Fax Number	:	215-790-0355

Provider Business Practice Location Address
First Line	:	273 S 15TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-5060
Country	:	US
Telephone Number	:	215-735-6337
Fax Number	:	215-790-0355

Authorized Official
Title or Position	:	OWNER
Name	:	JOAN IPPOLITI
Credential	:	RPH
Telephone Number	:	215-735-6337

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	04/26/2016

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