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General NPI Number Information
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NPI Number | 1720383920
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Entity Type | Organization
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Legal Business Name | MT AIRY FAMILY PHARMACY
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 5715 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2136
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Country | US
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Telephone | 215-242-3814
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Fax | 215-242-3818
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Provider Business Mailing Address
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Address Line | 5715 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2136
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Country | US
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Telephone | 215-242-3814
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Fax | 215-242-3818
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Authorized Official
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Title or Position | PHARMACY MANAGER/CO-OWNER
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Name | DR. OLALEKAN ABIFARIN
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Credential | PHARM D,CPH
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Telephone | 215-242-3814
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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 | PP482089
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License Number State | PA
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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 | PP482089
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License Number State | PA
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