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General NPI Number Information
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NPI Number | 1770848467
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Entity Type | Organization
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Legal Business Name | MLS PHARMACY LLC
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 700 S HENDERSON RD STE 308C
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-4206
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Country | US
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Telephone | 610-717-5588
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Fax | 610-717-5589
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Provider Business Mailing Address
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Address Line | 700 S HENDERSON RD STE 308C
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-4206
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Country | US
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Telephone | 610-717-5588
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Fax | 610-717-5589
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Authorized Official
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Title or Position | MEMBER
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Name | PHILLIP SHIN
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Credential |
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Telephone | 610-717-5588
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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 | RP443998
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License Number State | PA
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