Provider Demographics
NPI:1114559713
Name:BROAD AND SNYDER PHARMACY P C
Entity Type:Organization
Organization Name:BROAD AND SNYDER PHARMACY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-679-8850
Mailing Address - Street 1:2108 S BROAD ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3905
Mailing Address - Country:US
Mailing Address - Phone:267-324-3039
Mailing Address - Fax:267-519-2192
Practice Address - Street 1:2108 S BROAD ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3905
Practice Address - Country:US
Practice Address - Phone:267-324-3039
Practice Address - Fax:267-519-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy