Provider Demographics
NPI:1215307772
Name:B & A PHARMACY CORP
Entity type:Organization
Organization Name:B & A PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NNAWUIHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-278-1899
Mailing Address - Street 1:3138 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-2421
Mailing Address - Country:US
Mailing Address - Phone:215-309-5701
Mailing Address - Fax:215-309-5713
Practice Address - Street 1:3138 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-2421
Practice Address - Country:US
Practice Address - Phone:215-309-5701
Practice Address - Fax:215-309-5713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
PAPP4825843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154268OtherPK