Healthcare Provider Details

I. General information

NPI: 1366072969
Provider Name (Legal Business Name): DR. VINU ABRAHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 CASTOR AVE
PHILADELPHIA PA
19149-2792
US

IV. Provider business mailing address

2736 WELSH RD
PHILADELPHIA PA
19152-1525
US

V. Phone/Fax

Practice location:
  • Phone: 215-535-2800
  • Fax:
Mailing address:
  • Phone: 215-847-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453972
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: