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General NPI Number Information
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NPI Number | 1417240367
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Entity Type | Organization
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Legal Business Name | FALLS DRUG STORE
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 3300 HENRY AVE STE 103
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1121
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Country | US
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Telephone | 267-331-5421
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Fax | 267-331-5418
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Provider Business Mailing Address
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Address Line | 3300 HENRY AVE SUITE 103
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1121
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Country | US
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Telephone | 267-331-5421
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Fax | 267-331-5418
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Authorized Official
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Title or Position | OWNER
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Name | BETH DEWAN
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Credential |
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Telephone | 267-331-5421
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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 | PP487141
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License Number State | PA
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