Provider Demographics
NPI:1780822155
Name:PHILLY DRUGSTORE LLC
Entity Type:Organization
Organization Name:PHILLY DRUGSTORE LLC
Other - Org Name:PHILLY DRUGSTORE
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER/CHIEF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHADD
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-423-1368
Mailing Address - Street 1:2729 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-2702
Mailing Address - Country:US
Mailing Address - Phone:215-423-1368
Mailing Address - Fax:215-423-0244
Practice Address - Street 1:2729 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-2702
Practice Address - Country:US
Practice Address - Phone:215-423-1368
Practice Address - Fax:215-423-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410620L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy