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General NPI Number Information
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NPI Number | 1679572887
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Entity Type | Organization
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Legal Business Name | THOMAS J BETTERIDGE
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 2065 SNYDER AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2811
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Country | US
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Telephone | 215-334-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 2065 SNYDER AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2811
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Country | US
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Telephone | 215-334-4477
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | THOMAS BETTERIDGE
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Credential |
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Telephone | 215-334-4477
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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 | PP412139L
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License Number State | PA
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