=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346554516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMILLIA D COHEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2010
-----------------------------------------------------
Last Update Date | 08/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2512 ISLAND AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19153-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-937-9665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 PLEASANT RD
-----------------------------------------------------
City | YEADON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19050-3611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-284-9427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP030598L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------