Provider Demographics
NPI:1063655389
Name:PHARMACY OF AMERICA INC
Entity Type:Organization
Organization Name:PHARMACY OF AMERICA INC
Other - Org Name:PHARMACY OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OPERATION SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-744-0300
Mailing Address - Street 1:4654 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-1420
Mailing Address - Country:US
Mailing Address - Phone:215-744-0030
Mailing Address - Fax:215-744-0333
Practice Address - Street 1:1500 E ERIE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5642
Practice Address - Country:US
Practice Address - Phone:215-289-9500
Practice Address - Fax:215-289-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4819213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120307OtherPK