MEDICARE: MS. DALE FISCHER BLUM RPH

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	RP028959L	PA
2	183500000X	Pharmacist	PP411788L	PA

General Provider Information

NPI Number	:	1629247903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DALE FISCHER BLUM RPH

Provider Business Mailing Address
First Line	:	30 POLDER DR
Second Line	:
City	:	UPPER HOLLAND
State	:	PA
Zip	:	19053-1522
Country	:	US
Telephone Number	:	215-741-0147
Fax Number	:	215-741-3540

Provider Business Practice Location Address
First Line	:	8716 FRANKFORD AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19136-1315
Country	:	US
Telephone Number	:	215-331-0200
Fax Number	:	215-338-7788

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

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	02/21/2008

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