Healthcare Provider Details

I. General information

NPI: 1659888782
Provider Name (Legal Business Name): LORA SPASOVA-BACHVAROVA PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5272 TORRESDALE AVE
PHILADELPHIA PA
19124-2041
US

IV. Provider business mailing address

9654 EVANS ST
PHILADELPHIA PA
19115-3325
US

V. Phone/Fax

Practice location:
  • Phone: 215-535-6854
  • Fax:
Mailing address:
  • Phone: 267-243-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449315
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: