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General NPI Number Information
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NPI Number | 1225315682
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Entity Type | Organization
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Legal Business Name | KREWSTOWN PHARMACY
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Dates
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Enumeration Date | 11/12/2011
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 9313 KREWSTOWN RD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3710
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Country | US
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Telephone | 215-673-7373
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Fax |
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Provider Business Mailing Address
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Address Line | 9313 KREWSTOWN RD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3710
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Country | US
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Telephone | 215-673-7373
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. DEVASSYKUTTY K VAREED
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Credential | BSC, BPHARM, RPH
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Telephone | 215-673-7373
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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 | PP482214
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License Number State | PA
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