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General NPI Number Information
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NPI Number | 1093234171
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Entity Type | Organization
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Legal Business Name | 2209 MACDADE, LLC
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 2209 MACDADE BLVD
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City | HOLMES
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State | PA
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Zip | 19043-1222
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Country | US
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Telephone | 610-461-4123
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Fax | 610-461-2796
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Provider Business Mailing Address
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Address Line | 2209 MACDADE BLVD
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City | HOLMES
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State | PA
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Zip | 19043-1222
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Country | US
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Telephone | 610-461-4123
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Fax | 610-461-2796
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Authorized Official
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Title or Position | MEMBER
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Name | LILLIAN WALKER
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Credential |
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Telephone | 610-328-5778
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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 | PP413732L
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License Number State | PA
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