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General NPI Number Information
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NPI Number | 1891330031
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Entity Type | Organization
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Legal Business Name | PENNCARE PHARMACY
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 416 OAK LN
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City | PHILADELPHIA
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State | PA
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Zip | 19126-3136
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Country | US
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Telephone | 215-444-7525
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Fax |
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Provider Business Mailing Address
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Address Line | 4427 MASTER AVE
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City | TREVOSE
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State | PA
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Zip | 19053-6926
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Country | US
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Telephone | 215-444-7525
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH K JIBI
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Credential | RPH
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Telephone | 615-335-2760
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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 |
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License Number State |
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