MEDICARE: 65TH & WOODLAND 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP414901L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2121766	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750401014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	65TH & WOODLAND PHARMACY INC

Provider Business Mailing Address
First Line	:	6548 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-2215
Country	:	US
Telephone Number	:	215-727-9501
Fax Number	:	215-727-9502

Provider Business Practice Location Address
First Line	:	6548 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-2215
Country	:	US
Telephone Number	:	215-727-9501
Fax Number	:	215-727-9502

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	OLUSEYI ABDUL
Credential	:
Telephone Number	:	215-727-9501

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	09/19/2025

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