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General NPI Number Information
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NPI Number | 1265452197
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Entity Type | Organization
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Legal Business Name | SQA PHARMACY SERVICES LLC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 4700 WISSAHICKON AVE STE B108
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City | PHILADELPHIA
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State | PA
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Zip | 19144-4248
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Country | US
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Telephone | 215-438-3308
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Fax | 215-951-6285
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Provider Business Mailing Address
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Address Line | 4700 WISSAHICKON AVE STE B108
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City | PHILADELPHIA
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State | PA
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Zip | 19144-4248
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Country | US
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Telephone | 215-438-3308
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Fax | 215-951-6285
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Authorized Official
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Title or Position | FINANCIAL ANALYST
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Name | KELLY BRADY
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Credential |
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Telephone | 215-438-3308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PP481603
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License Number State | PA
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