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General NPI Number Information
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NPI Number | 1033115928
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Entity Type | Organization
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Legal Business Name | GARY'S RX SHOPPE
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 33 E STREET RD
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-6047
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Country | US
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Telephone | 215-364-8770
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Fax | 215-364-1792
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Provider Business Mailing Address
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Address Line | 33 E STREET RD
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City | FEASTERVILLE TREVOSE
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State | PA
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Zip | 19053-6047
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Country | US
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Telephone | 215-364-8770
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Fax | 215-364-1792
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Authorized Official
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Title or Position | PRESIDENT-RPH
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Name | IRA GARY FRIED
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Credential | R.PH.
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Telephone | 215-364-8770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PP413261L
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License Number State | PA
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