Healthcare Provider Details

I. General information

NPI: 1083993349
Provider Name (Legal Business Name): NICHOLAS OWENS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 43RD ST BOX 34
PHILADELPHIA PA
19104-4418
US

IV. Provider business mailing address

600 S 43RD ST BOX 34
PHILADELPHIA PA
19104-4418
US

V. Phone/Fax

Practice location:
  • Phone: 215-596-7233
  • Fax:
Mailing address:
  • Phone: 215-596-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number28RI03789000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP443606
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPI001434
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: