Healthcare Provider Details

I. General information

NPI: 1841296043
Provider Name (Legal Business Name): LANSDOWNE AVE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5943 LANSDOWNE AVE
PHILADELPHIA PA
19151-3932
US

IV. Provider business mailing address

5943 LANSDOWNE AVE
PHILADELPHIA PA
19151-3932
US

V. Phone/Fax

Practice location:
  • Phone: 215-877-0700
  • Fax: 215-877-4700
Mailing address:
  • Phone: 215-877-0700
  • Fax: 215-877-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP481416
License Number StatePA

VIII. Authorized Official

Name: MRS. SUSAN C FORBES
Title or Position: OWNER
Credential:
Phone: 215-877-2700