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General NPI Number Information
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NPI Number | 1457740300
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Entity Type | Organization
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Legal Business Name | MTP RX LLC
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 255 S 17TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6231
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Country | US
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Telephone | 215-545-3525
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Fax | 215-732-7013
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Provider Business Mailing Address
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Address Line | 255 S 17TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6231
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Country | US
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Telephone | 215-545-3525
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Fax | 215-732-7013
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Authorized Official
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Title or Position | MEMBER
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Name | ANTONIO SELLECCHIA
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Credential |
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Telephone | 215-624-0919
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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 | PP410793L
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License Number State | PA
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