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General NPI Number Information
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NPI Number | 1356405930
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Entity Type | Organization
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Legal Business Name | DAVIDEJA LLC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 249 S 52ND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-4148
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Country | US
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Telephone | 215-748-0800
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Fax | 215-748-1269
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Provider Business Mailing Address
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Address Line | 249 S. 52ND STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19139-9999
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Country | US
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Telephone | 215-748-0800
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Fax | 215-748-1269
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | MR. DAVID SIMMONS
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Credential | R.PH
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Telephone | 267-325-0139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP481376
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License Number State | PA
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