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General NPI Number Information
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NPI Number | 1043583644
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Entity Type | Organization
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Legal Business Name | PHARMACY OF AMERICA III INC
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 217 W LEHIGH AVE STORE #2
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City | PHILADELPHIA
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State | PA
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Zip | 19133-3421
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Country | US
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Telephone | 215-279-7981
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Fax | 267-687-7662
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Provider Business Mailing Address
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Address Line | 4654 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-1420
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Country | US
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Telephone | 215-744-0300
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Fax | 215-744-0333
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SABRI IBRAHIM
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Credential | PHARM D.
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Telephone | 267-237-1188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482270
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License Number State | PA
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