MEDICARE: GHANSHYAM HEALTHCARE 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	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PP482667	OTHER	PA	PENNSYLVANIA STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1992158208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHANSHYAM HEALTHCARE INC

Provider Business Mailing Address
First Line	:	460 W LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-3135
Country	:	US
Telephone Number	:	215-426-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 W LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-3135
Country	:	US
Telephone Number	:	215-426-5100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MITESHKUMAR PATEL
Credential	:
Telephone Number	:	215-426-5100

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	09/14/2016

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Directions to “GHANSHYAM HEALTHCARE INC ” Practice Location

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