MEDICARE: DR. CORNELIUS DUPREE PITTS PHARMD

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	RP027767L	PA

General Provider Information

NPI Number	:	1619312394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORNELIUS DUPREE PITTS PHARMD

Provider Business Mailing Address
First Line	:	6614 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3012
Country	:	US
Telephone Number	:	215-518-0466
Fax Number	:

Provider Business Practice Location Address
First Line	:	2938 N 22ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1504
Country	:	US
Telephone Number	:	215-518-0466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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