MEDICARE: A.A. DISPENSARY INC.

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
2	3336C0003X	Community/Retail Pharmacy	PP410263L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2079298	OTHER		PK

General Provider Information

NPI Number	:	1205837325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.A. DISPENSARY INC.

Provider Business Mailing Address
First Line	:	6552 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-2822
Country	:	US
Telephone Number	:	215-338-3262
Fax Number	:	215-338-1185

Provider Business Practice Location Address
First Line	:	6552 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-2822
Country	:	US
Telephone Number	:	215-338-3262
Fax Number	:	215-338-1185

Authorized Official
Title or Position	:	PRES
Name	:	DONNA HORGER
Credential	:	RPH
Telephone Number	:	215-338-3262

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	02/06/2017

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