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General NPI Number Information
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NPI Number | 1225312952
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Entity Type | Organization
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Legal Business Name | PHARMDIRECT RX
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 10/08/2011
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Provider Practice Location Address
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Address Line | 2308 GRAYS FERRY AVE P3
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1177
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Country | US
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Telephone | 215-732-0300
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Fax | 215-732-0305
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Provider Business Mailing Address
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Address Line | 2308 GRAYS FERRY AVE P3
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1177
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Country | US
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Telephone | 215-732-0300
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Fax | 215-732-0305
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DR. TYREESE M MCCREA
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Credential | PHARMD
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Telephone | 215-732-0300
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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 | PP482175
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License Number State | PA
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