MEDICARE: PHILARX PHARMACY 5

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PP482388	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2145172	OTHER		PK

General Provider Information

NPI Number	:	1013337682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILARX PHARMACY 5

Provider Business Mailing Address
First Line	:	2400 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4114
Country	:	US
Telephone Number	:	267-928-2149
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HAFIZ EBADY
Credential	:
Telephone Number	:	609-772-1314

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	05/01/2014

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Directions to “PHILARX PHARMACY 5 ” Practice Location

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