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General NPI Number Information
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NPI Number | 1376249102
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Entity Type | Organization
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Legal Business Name | GOLD PLUS MILK LLC
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 2212 ALMOND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3605
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Country | US
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Telephone | 215-380-5904
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 CHESTNUT ST # 1652
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2737
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL PARTNER
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Name | KIRA SY
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Credential | RD, IBCLC, LDN
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Telephone | 215-380-5904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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