Healthcare Provider Details

I. General information

NPI: 1316179211
Provider Name (Legal Business Name): EMACARE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 WILLITS RD
PHILADELPHIA PA
19152-1646
US

IV. Provider business mailing address

2718 WILLITS RD
PHILADELPHIA PA
19152-1646
US

V. Phone/Fax

Practice location:
  • Phone: 215-850-3031
  • Fax: 215-745-0808
Mailing address:
  • Phone: 215-850-3031
  • Fax: 215-745-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP441416
License Number StatePA

VIII. Authorized Official

Name: MR. ELTAYEB B ELHASSAN
Title or Position: PRESIDENT
Credential:
Phone: 215-850-3031