MEDICARE: 52ND & GIRARD 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1538654645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	52ND & GIRARD PHARMACY

Provider Business Mailing Address
First Line	:	1200 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-4315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-4315
Country	:	US
Telephone Number	:	215-588-6362
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	RATH HEAN
Credential	:
Telephone Number	:	470-332-6363

Provider Enumeration Date	:	06/30/2018
Last Update Date	:	06/30/2018

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