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General NPI Number Information
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NPI Number | 1154719524
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Entity Type | Organization
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Legal Business Name | LA VIDA DISCOUNT PHARMACY INC
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3204 KENSINGTON AVE FL 1 1ST FL
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City | PHILADELPHIA
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State | PA
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Zip | 19134-1918
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Country | US
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Telephone | 215-427-1603
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Fax | 215-427-3590
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Provider Business Mailing Address
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Address Line | 3204 KENSIGNTON AVE 1ST FL
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City | PHILADELPHIA
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State | PA
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Zip | 19134
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Country | US
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Telephone | 215-427-1603
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Fax |
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Authorized Official
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Title or Position | PHARMACY OWNER
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Name | PATRICK ASSIFUAH
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Credential |
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Telephone | 862-215-3414
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482534
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License Number State | PA
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