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NPI Code Detail

MEDICARE: PHARMDIRECT RX

MEDICARE: PHARMDIRECT RX
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
13336C0003XCommunity/Retail PharmacyPP482175PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PP482175OTHERPAPA PHARMACY LICENSE NUMBER

General Provider Information

NPI Number : 1225312952
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHARMDIRECT RX
Provider Business Mailing Address
First Line : 2308 GRAYS FERRY AVE
Second Line : P3
City : PHILADELPHIA
State : PA
Zip : 19146-1177
Country : US
Telephone Number : 215-732-0300
Fax Number : 215-732-0305
Provider Business Practice Location Address
First Line : 2308 GRAYS FERRY AVE
Second Line : P3
City : PHILADELPHIA
State : PA
Zip : 19146-1177
Country : US
Telephone Number : 215-732-0300
Fax Number : 215-732-0305
Authorized Official
Title or Position : OWNER/PHARMACIST
Name : DR. TYREESE M MCCREA
Credential : PHARMD
Telephone Number : 215-732-0300
Provider Enumeration Date : 09/29/2011
Last Update Date : 10/08/2011

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