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General NPI Number Information
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NPI Number | 1225028558
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Entity Type | Organization
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Legal Business Name | SOUSAN PHARMACY INC
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 8029 OLD YORK RD
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City | ELKINS PARK
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State | PA
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Zip | 19027-1413
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Country | US
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Telephone | 215-635-4200
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Fax | 215-635-3654
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Provider Business Mailing Address
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Address Line | 8029 OLD YORK RD
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City | ELKINS PARK
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State | PA
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Zip | 19027-1413
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Country | US
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Telephone | 215-635-4200
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Fax | 215-635-3654
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Authorized Official
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Title or Position | OWNER AND PRESIDENT
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Name | ELLIOTT HAAZ
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Credential | RPH
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Telephone | 215-635-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP412344L
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License Number State | PA
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