MEDICARE: WASHINGTON SQUARE 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP411092L	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	2079798	OTHER		PK

General Provider Information

NPI Number	:	1679546360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON SQUARE PHARMACY INC

Provider Business Mailing Address
First Line	:	241 S 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-3727
Country	:	US
Telephone Number	:	215-925-1466
Fax Number	:	215-829-0820

Provider Business Practice Location Address
First Line	:	241 S 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-3727
Country	:	US
Telephone Number	:	215-925-1466
Fax Number	:	215-829-0820

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GERARD VOLGRAF
Credential	:	RPH
Telephone Number	:	215-925-1466

Provider Enumeration Date	:	02/11/2006
Last Update Date	:	12/29/2015

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Directions to “WASHINGTON SQUARE PHARMACY INC ” Practice Location

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