Healthcare Provider Details

I. General information

NPI: 1538654645
Provider Name (Legal Business Name): 52ND & GIRARD PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2018
Last Update Date: 06/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 52ND ST
PHILADELPHIA PA
19131-4315
US

IV. Provider business mailing address

1200 N 52ND ST
PHILADELPHIA PA
19131-4315
US

V. Phone/Fax

Practice location:
  • Phone: 215-588-6362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RATH HEAN
Title or Position: PARTNER
Credential:
Phone: 470-332-6363