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General NPI Number Information
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NPI Number | 1669542197
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Entity Type | Organization
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Legal Business Name | NINTH STREET PHARMACY
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2400 S 9TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3716
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Country | US
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Telephone | 215-468-0497
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Fax |
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Provider Business Mailing Address
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Address Line | 1256 SEROTA DR
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City | PHILADELPHIA
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State | PA
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Zip | 19115-2526
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | MR. YURI SOROCHKIN
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Credential |
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Telephone | 215-468-0497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PP412224L
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License Number State | PA
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