Provider Demographics
NPI:1699183871
Name:JUST HERE III
Entity Type:Organization
Organization Name:JUST HERE III
Other - Org Name:BUSTLETON PHARMACY AND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:ASAFO
Authorized Official - Last Name:BOAKYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:267-250-3151
Mailing Address - Street 1:7923A BUSTLETON AVE.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152
Mailing Address - Country:US
Mailing Address - Phone:215-821-3524
Mailing Address - Fax:
Practice Address - Street 1:7923A BUSTLETON AVE.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-821-3524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4824143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy