MEDICARE: PHILADELPHIA 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP481164	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2085985	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336142835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA PHARMACY INC

Provider Business Mailing Address
First Line	:	101-03 E LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125
Country	:	US
Telephone Number	:	215-425-2800
Fax Number	:	215-425-2889

Provider Business Practice Location Address
First Line	:	101-03 E LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125
Country	:	US
Telephone Number	:	215-425-2800
Fax Number	:	215-425-2889

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD OST
Credential	:	RPH
Telephone Number	:	215-425-2800

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/19/2017

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