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NPI Code Detail

MEDICARE: STACEY MARIAM PHILIP

MEDICARE: STACEY MARIAM PHILIP
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
1183500000XPharmacistRP451116PA

General Provider Information

NPI Number : 1275083743
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY MARIAM PHILIP
Provider Business Mailing Address
First Line : 2503 WELSH RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19114-3238
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2503 WELSH RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19114-3238
Country : US
Telephone Number : 215-671-0544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2016
Last Update Date : 10/09/2016

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Directions to “ STACEY MARIAM PHILIP ” Practice Location

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