Provider Demographics
NPI:1518273952
Name:OVERBROOK PLAZA PHARMACY
Entity Type:Organization
Organization Name:OVERBROOK PLAZA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EWNETU
Authorized Official - Middle Name:
Authorized Official - Last Name:ZERIHUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:484-431-8761
Mailing Address - Street 1:5610 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3425
Mailing Address - Country:US
Mailing Address - Phone:215-921-3656
Mailing Address - Fax:215-921-3666
Practice Address - Street 1:5610 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-3425
Practice Address - Country:US
Practice Address - Phone:215-921-3656
Practice Address - Fax:215-921-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4820543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy