MEDICARE: SQA PHARMACY SERVICES 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
2	3336L0003X	Long Term Care Pharmacy	PP481603	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	2087856	OTHER		PK

General Provider Information

NPI Number	:	1265452197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SQA PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	4700 WISSAHICKON AVE
Second Line	:	STE B108
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-4248
Country	:	US
Telephone Number	:	215-438-3308
Fax Number	:	215-951-6285

Provider Business Practice Location Address
First Line	:	4700 WISSAHICKON AVE
Second Line	:	STE B108
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-4248
Country	:	US
Telephone Number	:	215-438-3308
Fax Number	:	215-951-6285

Authorized Official
Title or Position	:	FINANCIAL ANALYST
Name	:	KELLY BRADY
Credential	:
Telephone Number	:	215-438-3308

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	11/22/2016

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Directions to “SQA PHARMACY SERVICES LLC ” Practice Location

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