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General NPI Number Information
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NPI Number | 1679972780
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Entity Type | Organization
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Legal Business Name | RISING SUN PHARMACY INC
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 500 DEVEREAUX AVE A
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5767
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Country | US
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Telephone | 215-613-6272
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Fax | 215-613-7093
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Provider Business Mailing Address
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Address Line | 9307 LARAMIE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-2737
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Country | US
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Telephone | 267-977-8259
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Fax | 215-613-7093
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MRS. BINDU MATHEW
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Credential | RPH
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Telephone | 267-977-8259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482458
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License Number State | PA
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