Provider Demographics
NPI:1699912501
Name:PHILARX PHARMACY 1 INC
Entity type:Organization
Organization Name:PHILARX PHARMACY 1 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAFIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:EBADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-880-7905
Mailing Address - Street 1:418 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1535
Mailing Address - Country:US
Mailing Address - Phone:215-880-7905
Mailing Address - Fax:215-224-5416
Practice Address - Street 1:1742 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146
Practice Address - Country:US
Practice Address - Phone:267-324-5231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4818633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3991583OtherNCPDP PROVIDER IDENTIFICATION NUMBER