Broad St Pharmacy

Primary specialty

PharmacyTaxonomy code 333600000X

License

PP414363L Issued in PA

Legal business name

BROAD ST PHARMACY

Practice address

1412 S Broad St
Philadelphia, PA 19146

Phone

(215) 755-2010

Fax

(215) 940-1266

NPI assigned

Apr 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Morris J White Sr., RPH

Title

Owner RPH

Phone

(215) 755-2010

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187654400000",
    "number": "1376769869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19146",
            "telephone_number": "215-755-2010",
            "fax_number": "215-940-1266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19146",
            "telephone_number": "215-755-2010",
            "fax_number": "215-940-1266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD ST PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-08-21",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "MORRIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER RPH",
        "authorized_official_telephone_number": "215-755-2010",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP414363L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00121699",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "3961047",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Philadelphia, PA
• Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.