MEDICARE: INDEPENDENT APOTHECARY INCORPORATED

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	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PP481544	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2087681	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760402606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT APOTHECARY INCORPORATED

Provider Business Mailing Address
First Line	:	2923 E THOMPSON ST
Second Line	:	1ST FLR FRONT
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4812
Country	:	US
Telephone Number	:	215-739-0548
Fax Number	:	215-739-1579

Provider Business Practice Location Address
First Line	:	2923 E THOMPSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4812
Country	:	US
Telephone Number	:	215-739-0548
Fax Number	:	215-739-1579

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	JAMES CIRILLO
Credential	:
Telephone Number	:	215-739-0548

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/01/2024

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