MEDICARE: SOMERTON PHARMACY 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1255998563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMERTON PHARMACY INC.

Provider Business Mailing Address
First Line	:	206 VILLAGE GREEN LN
Second Line	:
City	:	TELFORD
State	:	PA
Zip	:	18969-1850
Country	:	US
Telephone Number	:	215-722-2220
Fax Number	:

Provider Business Practice Location Address
First Line	:	10806 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3302
Country	:	US
Telephone Number	:	215-969-9700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NAZAR UGHRYN
Credential	:
Telephone Number	:	215-722-2220

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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Directions to “SOMERTON PHARMACY INC. ” Practice Location

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