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General NPI Number Information
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NPI Number | 1649709460
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Entity Type | Organization
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Legal Business Name | PENN MEDICAL PHARMACY LLC
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 06/06/2017
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Provider Practice Location Address
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Address Line | 385 OXFORD VALLEY RD UNIT 5
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City | YARDLEY
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State | PA
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Zip | 19067-7700
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Country | US
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Telephone | 215-960-9010
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Fax | 215-960-9011
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Provider Business Mailing Address
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Address Line | 385 OXFORD VALLEY RD UNIT 5
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City | YARDLEY
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State | PA
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Zip | 19067-7700
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Country | US
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Telephone | 215-960-9010
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Fax | 215-960-9011
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | HEMIN VAIDYA VAIDYA
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Credential |
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Telephone | 908-930-9417
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3529074
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License Number State | PA
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