MEDICARE: MEDICAL TOWER 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	PP410793L	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	PP410793L	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1356371587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL TOWER PHARMACY INC

Provider Business Mailing Address
First Line	:	255 S 17TH ST
Second Line	:	GROUND FLOOR
City	:	PHILA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-545-3525
Fax Number	:	215-732-7013

Provider Business Practice Location Address
First Line	:	255 S 17TH ST
Second Line	:	GROUND FLOOR
City	:	PHILA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-545-3525
Fax Number	:	215-732-7013

Authorized Official
Title or Position	:	PHARMACIST MANAGER
Name	:	MR. DANIEL B HELLER
Credential	:	RPH
Telephone Number	:	215-545-3525

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	03/07/2023

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Directions to “MEDICAL TOWER PHARMACY INC ” Practice Location

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