MEDICARE: GOODHEART PHARMACY

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	302R00000X	Health Maintenance Organization	PP482140	PA

General Provider Information

NPI Number	:	1033505730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODHEART PHARMACY

Provider Business Mailing Address
First Line	:	4835 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4433
Country	:	US
Telephone Number	:
Fax Number	:	215-724-3301

Provider Business Practice Location Address
First Line	:	4835 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4433
Country	:	US
Telephone Number	:	215-724-3300
Fax Number	:	215-724-3301

Authorized Official
Title or Position	:	PHARMACIST
Name	:	OBIOMA AGUOCHA
Credential	:
Telephone Number	:	215-724-3300

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	04/09/2015

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Directions to “GOODHEART PHARMACY ” Practice Location

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