Healthcare Provider Details

I. General information

NPI: 1215254628
Provider Name (Legal Business Name): MR. SHAJI JOSEPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 OGONTZ AVE
PHILADELPHIA PA
19138-1323
US

IV. Provider business mailing address

94 W LYNFORD RD
RICHBORO PA
18954-1379
US

V. Phone/Fax

Practice location:
  • Phone: 215-224-9997
  • Fax: 215-224-3922
Mailing address:
  • Phone: 215-778-8350
  • Fax: 215-942-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040861L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: