MEDICARE: EMMAH ANDY R.PH.

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	183500000X	Pharmacist	RP031475L	PA

General Provider Information

NPI Number	:	1073618625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMAH ANDY R.PH.

Provider Business Mailing Address
First Line	:	500 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1613
Country	:	US
Telephone Number	:	215-685-6864
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 W DAUPHIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-4627
Country	:	US
Telephone Number	:	215-685-2419
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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