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NPI Code Detail

MEDICARE: LANSDOWNE AVE PHARMACY

MEDICARE: LANSDOWNE AVE 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
1333600000XPharmacyPP481416PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13983738OTHERPANCPDB

General Provider Information

NPI Number : 1841296043
Entity Type Code : Organization
Provider Name (Legal Business Name) : LANSDOWNE AVE PHARMACY
Provider Business Mailing Address
First Line : 5943 LANSDOWNE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19151-3932
Country : US
Telephone Number : 215-877-0700
Fax Number : 215-877-4700
Provider Business Practice Location Address
First Line : 5943 LANSDOWNE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19151-3932
Country : US
Telephone Number : 215-877-0700
Fax Number : 215-877-4700
Authorized Official
Title or Position : OWNER
Name : MRS. SUSAN C FORBES
Credential :
Telephone Number : 215-877-2700
Provider Enumeration Date : 06/22/2005
Last Update Date : 08/22/2020

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Practice Location Address:
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1336013929 — LUIS SOTELO MSN, CRNP, FNP-BC
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Directions to “LANSDOWNE AVE PHARMACY ” Practice Location

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