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General NPI Number Information
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NPI Number | 1326382888
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Entity Type | Organization
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Legal Business Name | ART OF MEDICINE
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 507 S 2ND ST 1ST FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19147-2408
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Country | US
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Telephone | 215-238-9055
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Fax |
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Provider Business Mailing Address
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Address Line | 507 S 2ND ST 1ST FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19147-2408
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Country | US
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Telephone | 215-238-9055
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACK KORBUTOV
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Credential |
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Telephone | 215-238-9055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PP482313
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License Number State | PA
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