Provider Demographics
NPI:1922245315
Name:JUST HERE LLC
Entity Type:Organization
Organization Name:JUST HERE LLC
Other - Org Name:JUST HERE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAKYE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-228-3470
Mailing Address - Street 1:3800 N BROAD ST
Mailing Address - Street 2:UNIT #2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-3610
Mailing Address - Country:US
Mailing Address - Phone:215-228-3470
Mailing Address - Fax:215-228-3473
Practice Address - Street 1:3800 N BROAD ST
Practice Address - Street 2:UNIT #2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-3610
Practice Address - Country:US
Practice Address - Phone:215-228-3470
Practice Address - Fax:215-228-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4818913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022799430001Medicaid
2119184OtherPK
PA1022799430001Medicaid