Healthcare Provider Details

I. General information

NPI: 1235125246
Provider Name (Legal Business Name): GARRETT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 06/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GARRETT RD
UPPER DARBY PA
19082-3106
US

IV. Provider business mailing address

140 GARRETT RD
UPPER DARBY PA
19082-3106
US

V. Phone/Fax

Practice location:
  • Phone: 610-352-2477
  • Fax: 610-352-3911
Mailing address:
  • Phone: 610-352-2477
  • Fax: 610-352-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP033704L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP414602L
License Number StatePA

VIII. Authorized Official

Name: MRS. KIM PHAM NGUYEN
Title or Position: OWNER, PHARMACIST-IN-CHARGE
Credential: R.PH.
Phone: 610-352-2477