Provider Demographics
NPI:1467587337
Name:ND PHARMACY INC.
Entity Type:Organization
Organization Name:ND PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NGAN
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-324-8477
Mailing Address - Street 1:5012 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2707
Mailing Address - Country:US
Mailing Address - Phone:215-324-8477
Mailing Address - Fax:215-324-8488
Practice Address - Street 1:5012 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2707
Practice Address - Country:US
Practice Address - Phone:215-324-8477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012198210003Medicaid
PA5038620001Medicare NSC