Provider Demographics
NPI:1235125246
Name:GARRETT PHARMACY
Entity Type:Organization
Organization Name:GARRETT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:PHAM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-352-2477
Mailing Address - Street 1:140 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3106
Mailing Address - Country:US
Mailing Address - Phone:610-352-2477
Mailing Address - Fax:610-352-3911
Practice Address - Street 1:140 GARRETT RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-3106
Practice Address - Country:US
Practice Address - Phone:610-352-2477
Practice Address - Fax:610-352-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033704L183500000X
PAPP414602L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001664408Medicaid