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General NPI Number Information
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NPI Number | 1558587030
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Entity Type | Organization
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Legal Business Name | CHRISTIAN ST PHARMACY
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1947 CHRISTIAN STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19146
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Country | US
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Telephone | 215-545-3582
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Fax | 215-545-3583
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Provider Business Mailing Address
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Address Line | 1947 CHRISTIAN STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19146
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Country | US
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Telephone | 215-545-3582
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Fax | 215-545-3583
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. JEROME P WHACK
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Credential | RPH
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Telephone | 215-545-3582
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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 | PP412075L
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License Number State | PA
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