Healthcare Provider Details

I. General information

NPI: 1003954488
Provider Name (Legal Business Name): WYCOMBE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 W LEHIGH AVE
PHILADELPHIA PA
19133-1640
US

IV. Provider business mailing address

1006 W LEHIGH AVE
PHILADELPHIA PA
19133-1640
US

V. Phone/Fax

Practice location:
  • Phone: 215-225-7522
  • Fax: 215-225-7525
Mailing address:
  • Phone: 215-225-7522
  • Fax: 215-225-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPP481048
License Number StatePA

VIII. Authorized Official

Name: MR. PAUL CARMEN SCOTA
Title or Position: PHARMACIST & OWNER
Credential: R.PH.
Phone: 215-225-7522