Provider Demographics
NPI:1225315682
Name:KREWSTOWN PHARMACY
Entity Type:Organization
Organization Name:KREWSTOWN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVASSYKUTTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:VAREED
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, BPHARM, RPH
Authorized Official - Phone:215-673-7373
Mailing Address - Street 1:9313 KREWSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3710
Mailing Address - Country:US
Mailing Address - Phone:215-673-7373
Mailing Address - Fax:
Practice Address - Street 1:9313 KREWSTOWN RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3710
Practice Address - Country:US
Practice Address - Phone:215-673-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-12
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4822143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy