MEDICARE: EJ CORPORATION

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	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PP482610	PA

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	2157332	OTHER		PK

General Provider Information

NPI Number	:	1992160279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EJ CORPORATION

Provider Business Mailing Address
First Line	:	767 CLAIRE RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1542
Country	:	US
Telephone Number	:	267-690-1211
Fax Number	:

Provider Business Practice Location Address
First Line	:	257 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-1502
Country	:	US
Telephone Number	:	267-292-5011
Fax Number	:	267-292-5403

Authorized Official
Title or Position	:	CEO
Name	:	YONG LI
Credential	:
Telephone Number	:	267-690-1211

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	05/01/2017

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Directions to “EJ CORPORATION ” Practice Location

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