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General NPI Number Information
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NPI Number | 1710221262
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Entity Type | Organization
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Legal Business Name | SAN JUAN DE DIOS LLC
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Dates
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Enumeration Date | 11/22/2012
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 961 N 10TH ST
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City | READING
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State | PA
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Zip | 19604-2353
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Country | US
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Telephone | 610-743-4501
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Fax |
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Provider Business Mailing Address
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Address Line | 2122 GALLOWAY RD
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City | BENSALEM
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State | PA
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Zip | 19020-2988
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Country | US
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Telephone | 267-206-3861
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NEETA TRIPATHI
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Credential |
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Telephone | 267-206-3861
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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 | PP482330
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License Number State | PA
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