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General NPI Number Information
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NPI Number | 1366817991
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Entity Type | Organization
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Legal Business Name | PENNSPORT MALL PHARMACY LLC
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 237 MCCLELLAN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1954
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Country | US
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Telephone | 267-639-4657
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Fax | 267-687-2583
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Provider Business Mailing Address
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Address Line | 237 MCCLELLAN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148
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Country | US
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Telephone | 267-639-4657
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Fax | 267-687-2583
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | GINO CUFFARI
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Credential |
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Telephone | 267-340-7534
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482611
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License Number State | PA
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