Healthcare Provider Details

I. General information

NPI: 1972503589
Provider Name (Legal Business Name): FRIENDSHIP PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 COTTMAN AVE
PHILADELPHIA PA
19149-1601
US

IV. Provider business mailing address

3300 COTTMAN AVE
PHILADELPHIA PA
19149-1601
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-0440
  • Fax: 215-624-3902
Mailing address:
  • Phone: 215-624-0440
  • Fax: 215-624-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPP410815L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPPA10815
License Number StatePA

VIII. Authorized Official

Name: MR. FRANK A RUBINO
Title or Position: PRES/OWNER
Credential: RPH
Phone: 215-624-0440