Healthcare Provider Details

I. General information

NPI: 1932570546
Provider Name (Legal Business Name): 11TH STREET PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N 11TH ST FL 1 RM 148
PHILADELPHIA PA
19123-1957
US

IV. Provider business mailing address

PO BOX 3704
PHILADELPHIA PA
19125-0704
US

V. Phone/Fax

Practice location:
  • Phone: 215-769-2155
  • Fax: 267-793-0048
Mailing address:
  • Phone: 215-769-2155
  • Fax: 267-793-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StatePA

VIII. Authorized Official

Name: ADAM ACCAY
Title or Position: PRESIDENT
Credential:
Phone: 215-500-2223