1831579036 NPI number — DESTINY PHARMACY OF AMERICA INC.

Table of content: (NPI 1831579036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831579036 NPI number — DESTINY PHARMACY OF AMERICA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESTINY PHARMACY OF AMERICA INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DESTINY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831579036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7712 ORPHEUS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19153-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-257-5868
Provider Business Mailing Address Fax Number:
215-921-5247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6037 WOODLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19142-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-796-9381
Provider Business Practice Location Address Fax Number:
215-921-5247
Provider Enumeration Date:
06/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SHASANYA
Authorized Official First Name:
AKINOLA
Authorized Official Middle Name:
AYODELE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-796-9381

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PP482548 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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