Healthcare Provider Details

I. General information

NPI: 1619195104
Provider Name (Legal Business Name): JFK MEDICAL CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 WALNUT ST FL 4
PHILADELPHIA PA
19104-3414
US

IV. Provider business mailing address

3001 WALNUT ST FL 4
PHILADELPHIA PA
19104-3414
US

V. Phone/Fax

Practice location:
  • Phone: 215-386-4708
  • Fax:
Mailing address:
  • Phone: 215-386-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPP418375L
License Number StatePA

VIII. Authorized Official

Name: CHERIAN ABRAHAM
Title or Position: PHARMACY MANAGER
Credential: R.PH.
Phone: 215-386-4708