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General NPI Number Information
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NPI Number | 1255720710
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Entity Type | Organization
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Legal Business Name | MY DOCTORS CHOICE, LLC
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 3430 PROGRESS DR SUITE H
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City | BENSALEM
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State | PA
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Zip | 19020-5812
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Country | US
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Telephone | 866-552-1928
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Fax |
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Provider Business Mailing Address
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Address Line | 3430 PROGRESS DR SUITE H
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City | BENSALEM
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State | PA
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Zip | 19020-5812
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Country | US
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Telephone | 866-552-1928
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MARK BANKER
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Credential |
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Telephone | 215-850-1949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 8000002643
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License Number State | PA
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