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General NPI Number Information
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NPI Number | 1093078180
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Entity Type | Organization
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Legal Business Name | GRACE POINT PHARMACY
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 6035 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-3207
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Country | US
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Telephone | 215-744-3800
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Fax | 215-744-3803
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Provider Business Mailing Address
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Address Line | 6035 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-3207
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Country | US
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Telephone | 215-744-3800
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Fax | 215-744-3803
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | DR. SIDNEY C MBAH
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Credential | PHARM D
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Telephone | 215-744-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PP482284
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License Number State | PA
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