MEDICARE: PHARMACY OF AMERICA V 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

General Provider Information

NPI Number	:	1225471204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY OF AMERICA V INC.

Provider Business Mailing Address
First Line	:	4654 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-1420
Country	:	US
Telephone Number	:	267-237-1188
Fax Number	:	215-744-0300

Provider Business Practice Location Address
First Line	:	232 W GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-1538
Country	:	US
Telephone Number	:	267-237-1188
Fax Number	:	215-744-0300

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DR. SABRI IBRAHIM
Credential	:	PHARM D.
Telephone Number	:	267-237-1188

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	05/03/2019

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