Provider Demographics
NPI:1154827103
Name:GILEAD PHARMACY INC
Entity Type:Organization
Organization Name:GILEAD PHARMACY INC
Other - Org Name:GILEAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STORE MGR, AO
Authorized Official - Prefix:
Authorized Official - First Name:FOLUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUSEUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-439-8292
Mailing Address - Street 1:1226 N 52ND ST. FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4315
Mailing Address - Country:US
Mailing Address - Phone:267-713-7066
Mailing Address - Fax:215-921-2708
Practice Address - Street 1:1226 N 52ND ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4315
Practice Address - Country:US
Practice Address - Phone:267-713-7066
Practice Address - Fax:215-921-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4827753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176474OtherPK