Healthcare Provider Details

I. General information

NPI: 1487967980
Provider Name (Legal Business Name): GIRARD AVENUE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348-50 W GIRARD AVE
PHILADELPHIA PA
19123
US

IV. Provider business mailing address

1348-50 W GIRARD AVE
PHILADELPHIA PA
19123
US

V. Phone/Fax

Practice location:
  • Phone: 215-236-1210
  • Fax: 215-236-1080
Mailing address:
  • Phone: 215-236-1210
  • Fax: 215-236-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP482036
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482036
License Number StatePA

VIII. Authorized Official

Name: FRANCIS BYRON
Title or Position: OWNER
Credential: RPH
Phone: 215-239-7003