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General NPI Number Information
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NPI Number | 1295049625
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Entity Type | Organization
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Legal Business Name | PACKER APOTHECARY
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 1532 PACKER AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19145-5407
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Country | US
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Telephone | 267-909-9814
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Fax |
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Provider Business Mailing Address
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Address Line | 1532 PACKER AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19145-5407
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Country | US
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Telephone | 267-909-9214
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Fax |
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Authorized Official
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Title or Position | MANANGER
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Name | CHRISTOPHER PAUZANO
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Credential |
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Telephone | 267-266-9270
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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 | PP482031
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License Number State | PA
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