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NPI Code Detail

MEDICARE: GANASA LLC

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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPP482398PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12144658OTHERPK

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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