MEDICARE: NORTH WEST 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	183500000X	Pharmacist	PP411913L	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	3940182	OTHER	PA	NABP

General Provider Information

NPI Number	:	1457362154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH WEST PHARMACY INC.

Provider Business Mailing Address
First Line	:	2024 N 22ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-1407
Country	:	US
Telephone Number	:	215-232-9222
Fax Number	:	215-232-9822

Provider Business Practice Location Address
First Line	:	2024 N 22ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-1407
Country	:	US
Telephone Number	:	215-232-9222
Fax Number	:	215-232-9822

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HENRY P LEE
Credential	:	RPH
Telephone Number	:	215-232-9222

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/22/2020

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Directions to “NORTH WEST PHARMACY INC. ” Practice Location

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