Healthcare Provider Details

I. General information

NPI: 1043538101
Provider Name (Legal Business Name): MR. FELIX COLOMB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 - 30 BALTIMORE AVE
PHILADELPHIA PA
19143-3240
US

IV. Provider business mailing address

5214-30 BALTIMORE AVENUE
PHILADELPHIA PA
19143-3240
US

V. Phone/Fax

Practice location:
  • Phone: 215-476-1724
  • Fax: 215-474-8354
Mailing address:
  • Phone: 215-476-1724
  • Fax: 215-474-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP441299
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: