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General NPI Number Information
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NPI Number | 1306975115
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Entity Type | Organization
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Legal Business Name | THE BEHAVIORAL WELLNESS CENTER AT GIRARD
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 801 W GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19122-4212
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Country | US
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Telephone | 215-787-2460
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Fax | 215-787-2321
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Provider Business Mailing Address
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Address Line | 801 W GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19122-4212
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Country | US
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Telephone | 215-787-2460
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Fax | 215-787-2321
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | TIM CROWLEY
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Credential |
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Telephone | 215-787-9359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | HP418185L
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License Number State | PA
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