MEDICARE: MCKEAN STREET PHARMACY

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	PP410094L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2081715	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528147295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKEAN STREET PHARMACY

Provider Business Mailing Address
First Line	:	2745 MCKEAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2513
Country	:	US
Telephone Number	:	215-334-4185
Fax Number	:	215-334-4784

Provider Business Practice Location Address
First Line	:	2745 MCKEAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2513
Country	:	US
Telephone Number	:	215-334-4185
Fax Number	:	215-334-4784

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL JIROTTO
Credential	:	RPH
Telephone Number	:	215-334-4185

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	02/22/2016

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Directions to “MCKEAN STREET PHARMACY ” Practice Location

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