=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063655389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHARMACY OF AMERICA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2009
-----------------------------------------------------
Last Update Date | 05/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 E ERIE AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19124-5642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-289-9500
-----------------------------------------------------
Fax | 215-289-9503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4654 N 5TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-744-0030
-----------------------------------------------------
Fax | 215-744-0333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY OPERATION SUPERVISOR
-----------------------------------------------------
Name | NORMA VELEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-744-0300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP481921
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------