Healthcare Provider Details

I. General information

NPI: 1780990028
Provider Name (Legal Business Name): MEGAN RENEE NAKHLA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 CASTOR AVE
PHILADELPHIA PA
19149-2708
US

IV. Provider business mailing address

438 E WILDEY ST
PHILADELPHIA PA
19125-4231
US

V. Phone/Fax

Practice location:
  • Phone: 215-535-2800
  • Fax:
Mailing address:
  • Phone: 518-894-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444998
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: