=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255998563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOMERTON PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2019
-----------------------------------------------------
Last Update Date | 05/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10806 BUSTLETON AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19116-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-969-9700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 VILLAGE GREEN LN
-----------------------------------------------------
City | TELFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18969-1850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-722-2220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NAZAR UGHRYN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-722-2220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------