Pharmacy at Ridge & Midvale

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP482271 Issued in PA

Legal business name

PHARMACY AT RIDGE & MIDVALE

Practice address

4219 Ridge Ave
Philadelphia, PA 19129-1745

Phone

(267) 385-6024

Fax

(267) 385-6238

NPI assigned

Nov 8, 2012

Organization subpart

No

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

Authorized official

Name

Kofi Dei Gbomita, PHARMD

Title

Owner/President/Ceo

Phone

(267) 664-2388

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1352332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352332800000",
    "number": "1609120930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4219 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291745",
            "telephone_number": "267-385-6024",
            "fax_number": "267-385-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4219 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291745",
            "telephone_number": "267-385-6024",
            "fax_number": "267-385-6238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACY AT RIDGE & MIDVALE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-08",
        "last_updated": "2012-11-08",
        "status": "A",
        "authorized_official_last_name": "GBOMITA",
        "authorized_official_first_name": "KOFI",
        "authorized_official_middle_name": "DEI",
        "authorized_official_title_or_position": "OWNER/PRESIDENT/CEO",
        "authorized_official_telephone_number": "267-664-2388",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP482271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; 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.