MEDICARE: BROAD & LEHIGH PHARMACY, INC

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	PP415177L	PA
2	3336C0003X	Community/Retail Pharmacy

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720082340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROAD & LEHIGH PHARMACY, INC

Provider Business Mailing Address
First Line	:	1300 W LEHIGH AVE
Second Line	:	SUITE 102
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2701
Country	:	US
Telephone Number	:	215-228-9007
Fax Number	:	215-228-9099

Provider Business Practice Location Address
First Line	:	1300 W LEHIGH AVE
Second Line	:	SUITE 102
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2701
Country	:	US
Telephone Number	:	215-228-9007
Fax Number	:	215-228-9099

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CYNTHIA NTEFO
Credential	:
Telephone Number	:	215-228-9007

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	05/14/2025

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Directions to “BROAD & LEHIGH PHARMACY, INC ” Practice Location

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