MEDICARE: COUZINS ENTERPRISES, LLC

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	:	1164988598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUZINS ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	2951 N 22ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1505
Country	:	US
Telephone Number	:	267-800-7087
Fax Number	:	267-800-7901

Provider Business Practice Location Address
First Line	:	2951 N 22ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1505
Country	:	US
Telephone Number	:	267-800-7087
Fax Number	:	267-800-7901

Authorized Official
Title or Position	:	MEMBER
Name	:	SHAI FELLAH
Credential	:
Telephone Number	:	267-800-7087

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	02/11/2019

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Directions to “COUZINS ENTERPRISES, LLC ” Practice Location

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