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NPI Code Detail

MEDICARE: FOUR STAR PHARMACY

MEDICARE: FOUR STAR 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
13336C0003XCommunity/Retail PharmacyPP482087PA

General Provider Information

NPI Number : 1700186004
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOUR STAR PHARMACY
Provider Business Mailing Address
First Line : 7028 ELMWOOD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19142-1722
Country : US
Telephone Number : 215-365-1088
Fax Number : 215-365-1699
Provider Business Practice Location Address
First Line : 7028 ELMWOOD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19142-1722
Country : US
Telephone Number : 215-365-1088
Fax Number : 215-365-1699
Authorized Official
Title or Position : PHARMACY MANAGER
Name : DR. CHARLES KWAME OPPONG
Credential : PHARM.D
Telephone Number : 215-365-1088
Provider Enumeration Date : 11/02/2010
Last Update Date : 11/02/2010

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Directions to “FOUR STAR PHARMACY ” Practice Location

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