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General NPI Number Information
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NPI Number | 1831579036
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Entity Type | Organization
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Legal Business Name | DESTINY PHARMACY OF AMERICA INC.
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 6037 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-2417
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Country | US
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Telephone | 215-796-9381
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Fax | 215-921-5247
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Provider Business Mailing Address
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Address Line | 7712 ORPHEUS PL
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City | PHILADELPHIA
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State | PA
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Zip | 19153-1717
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Country | US
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Telephone | 267-257-5868
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Fax | 215-921-5247
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. AKINOLA AYODELE SHASANYA
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Credential | RPH
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Telephone | 215-796-9381
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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 | PP482548
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License Number State | PA
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