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General NPI Number Information
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NPI Number | 1104274406
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Entity Type | Organization
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Legal Business Name | FKATAN LLC
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 5927 LANSDOWNE AVE FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19151-3932
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Country | US
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Telephone | 215-473-0750
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Fax | 215-473-1804
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Provider Business Mailing Address
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Address Line | 1607 S KEYSTONE AVE
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City | UPPER DARBY
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State | PA
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Zip | 19082-3514
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Country | US
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Telephone | 215-473-0750
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Fax | 215-473-1804
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. AYALEW TASSEW
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Credential | PHARMD
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Telephone | 202-365-5070
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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 | PP482650
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License Number State | PA
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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 |
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License Number State |
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