Healthcare Provider Details

I. General information

NPI: 1154827103
Provider Name (Legal Business Name): GILEAD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 N 52ND ST FL 1
PHILADELPHIA PA
19131-4315
US

IV. Provider business mailing address

1226 N 52ND ST. FL 1
PHILADELPHIA PA
19131-4315
US

V. Phone/Fax

Practice location:
  • Phone: 267-713-7066
  • Fax: 215-921-2708
Mailing address:
  • Phone: 267-713-7066
  • Fax: 215-921-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482775
License Number StatePA

VIII. Authorized Official

Name: FOLUKE ODUSEUN
Title or Position: STORE MGR, AO
Credential:
Phone: 267-439-8292