=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255633319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLESSED PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2010
-----------------------------------------------------
Last Update Date | 11/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2826 W GIRARD AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19130-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-765-2983
-----------------------------------------------------
Fax | 215-765-2984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BLESSED PHARMACY PO BOX 5642
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-765-2983
-----------------------------------------------------
Fax | 215-765-2984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECOR
-----------------------------------------------------
Name | CHRISTIANA ONU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-380-9508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PP482074
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------