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General NPI Number Information
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NPI Number | 1164828802
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Entity Type | Organization
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Legal Business Name | RYLA COMMUNITY PHARMACY
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 4301 MAPLE AVE UNIT A
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City | PENNSAUKEN
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State | NJ
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Zip | 08109-1818
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Country | US
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Telephone | 856-320-2609
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Fax | 856-320-2716
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Provider Business Mailing Address
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Address Line | 4301 MAPLE AVE UNIT A
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City | PENNSAUKEN
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State | NJ
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Zip | 08109-1818
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Country | US
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Telephone | 856-320-2609
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Fax | 856-320-2716
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | BUSHRA BOFAHREDIN
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Credential |
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Telephone | 856-313-7681
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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 | 28RS00736300
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License Number State | NJ
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