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General NPI Number Information
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NPI Number | 1760798359
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Entity Type | Organization
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Legal Business Name | WALNUT STREET APOTHECARY INC
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 1901 N 54TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19131-3221
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Country | US
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Telephone | 215-222-2400
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Fax | 215-222-2442
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Provider Business Mailing Address
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Address Line | 1006 W LEHIGH AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19133-1640
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Country | US
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Telephone | 215-225-7522
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Fax | 215-225-7525
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Authorized Official
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Title or Position | OWNER
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Name | PAUL SCOTA
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Credential |
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Telephone | 610-247-4122
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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 | PP482055
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License Number State | PA
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