MEDICARE: JFK MEDICAL CENTER 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	3336C0002X	Clinic Pharmacy	PP418375L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3965893	OTHER	PA	NCPDP

General Provider Information

NPI Number	:	1619195104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JFK MEDICAL CENTER PHARMACY

Provider Business Mailing Address
First Line	:	3001 WALNUT ST FL 4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3414
Country	:	US
Telephone Number	:	215-386-4708
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 WALNUT ST FL 4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3414
Country	:	US
Telephone Number	:	215-386-4708
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	CHERIAN ABRAHAM
Credential	:	R.PH.
Telephone Number	:	215-386-4708

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	03/13/2008

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