MEDICARE: DHANYABAPA 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	332B00000X	Durable Medical Equipment & Medical Supplies	PP482001	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	2140123	OTHER		PK

General Provider Information

NPI Number	:	1578895199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DHANYABAPA LLC

Provider Business Mailing Address
First Line	:	1701 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3802
Country	:	US
Telephone Number	:	215-728-6300
Fax Number	:	215-728-6302

Provider Business Practice Location Address
First Line	:	1701 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3802
Country	:	US
Telephone Number	:	215-728-6300
Fax Number	:	215-728-6302

Authorized Official
Title or Position	:	MEMBER
Name	:	SHARDABEN PATEL
Credential	:
Telephone Number	:	215-728-6300

Provider Enumeration Date	:	02/06/2010
Last Update Date	:	04/06/2017

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Directions to “DHANYABAPA LLC ” Practice Location

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