MEDICARE: BROAD AND SNYDER PHARMACY P C

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

General Provider Information

NPI Number	:	1114559713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROAD AND SNYDER PHARMACY P C

Provider Business Mailing Address
First Line	:	2108 S BROAD ST FL 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3905
Country	:	US
Telephone Number	:	267-324-3039
Fax Number	:	267-519-2192

Provider Business Practice Location Address
First Line	:	2108 S BROAD ST FL 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3905
Country	:	US
Telephone Number	:	267-324-3039
Fax Number	:	267-519-2192

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. KEVIN LAM
Credential	:
Telephone Number	:	267-679-8850

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/11/2020

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