MEDICARE: UNITED PHARMACY UPPER DARBY 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	PP481752	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3996886	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1811260938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED PHARMACY UPPER DARBY INC

Provider Business Mailing Address
First Line	:	PO BOX 25751
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-0751
Country	:	US
Telephone Number	:	215-438-3880
Fax Number	:	215-438-3883

Provider Business Practice Location Address
First Line	:	206B W CHELTEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3803
Country	:	US
Telephone Number	:	215-438-3880
Fax Number	:	215-438-3883

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICTORIA OBASI
Credential	:
Telephone Number	:	215-438-3880

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	02/21/2012

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