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General NPI Number Information
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NPI Number | 1962560565
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Entity Type | Organization
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Legal Business Name | SUBURBAN BUSTLETON PHARMACY INC.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 10875 BUSTLETON AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3301
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Country | US
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Telephone | 215-673-0994
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Fax | 215-969-6176
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Provider Business Mailing Address
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Address Line | 10875 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3301
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Country | US
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Telephone | 215-673-0994
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Fax | 215-969-6176
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Authorized Official
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Title or Position | OWNER
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Name | MS. JANE DZIERZA
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Credential |
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Telephone | 215-673-0994
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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 | PP412433L
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License Number State | PA
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