MEDICARE: GANASA 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	3336C0003X	Community/Retail Pharmacy	PP482398	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2144658	OTHER		PK

General Provider Information

NPI Number	:	1366868408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GANASA LLC

Provider Business Mailing Address
First Line	:	1251 S CEDAR CREST BLVD
Second Line	:	SUITE # 104
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6205
Country	:	US
Telephone Number	:	484-223-0215
Fax Number	:	484-223-0211

Provider Business Practice Location Address
First Line	:	2916 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2801
Country	:	US
Telephone Number	:	215-439-0943
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	UMESH PATEL
Credential	:
Telephone Number	:	484-274-5428

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	03/13/2014

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Directions to “GANASA LLC ” Practice Location

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