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General NPI Number Information
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NPI Number | 1619212032
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Entity Type | Organization
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Legal Business Name | FISHTOWN PHARMACY LLC
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 1802 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19125-2403
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Country | US
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Telephone | 267-687-7562
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Fax |
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Provider Business Mailing Address
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Address Line | 1802 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19125-2403
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Country | US
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Telephone | 267-687-7562
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BINTA PATEL
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Credential | PHARMD
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Telephone | 267-687-7562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PP482316
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PP482316
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License Number State | PA
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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 | PP482316
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License Number State | PA
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