MEDICARE: AVON DISCOUNT PHARMACY 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	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PP482913	OTHER	PA	STATE BOARD LICENSE

General Provider Information

NPI Number	:	1174172274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVON DISCOUNT PHARMACY LLC

Provider Business Mailing Address
First Line	:	10808 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3302
Country	:	US
Telephone Number	:	215-464-8600
Fax Number	:	215-464-8601

Provider Business Practice Location Address
First Line	:	10808 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3302
Country	:	US
Telephone Number	:	215-464-8600
Fax Number	:	215-464-8601

Authorized Official
Title or Position	:	PRESIDENT
Name	:	INNA SANDLER
Credential	:
Telephone Number	:	215-850-9594

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	01/06/2023

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Directions to “AVON DISCOUNT PHARMACY LLC ” Practice Location

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