=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629737085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUBLIC HEALTH MANAGEMENT CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2021
-----------------------------------------------------
Last Update Date | 12/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 N 12TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-586-4840
-----------------------------------------------------
Fax | 267-546-4324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 N 12TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-586-4840
-----------------------------------------------------
Fax | 267-546-4324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RICHARD COHEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-985-2501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------