Healthcare Provider Details

I. General information

NPI: 1609517747
Provider Name (Legal Business Name): JENKINTOWN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 OLD YORK RD LBBY 212
JENKINTOWN PA
19046-3724
US

IV. Provider business mailing address

261 OLD YORK RD LBBY 212
JENKINTOWN PA
19046-3724
US

V. Phone/Fax

Practice location:
  • Phone: 215-444-6241
  • Fax:
Mailing address:
  • Phone: 215-444-6241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DENNIS K ACQUAH
Title or Position: OWNER
Credential:
Phone: 215-330-4445