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| Type | Company | [sources] | |||
|---|---|---|---|---|---|
| Name | 52nd Street Pharmacy | [sources] | |||
| Incorporation date | not available | [sources] | |||
| Jurisdiction | not available | [sources] | |||
| Country | United States | [sources] | |||
| ID Number | PP482438 /RPI002536 · PROMISe #102900899 | [sources] | |||
| NPI | 1306261169 | [sources] | |||
| Registration number | not available | [sources] | |||
| Sector | 333600000X, 3336C003X | [sources] | |||
| Tax Number | 463303782 | [sources] | |||
| Address | Philadelphia, PA | [sources] | |||
| Last change | Last processed | First seen | |||
List of providers excluded from participating in the Delaware Medicaid program.
United States · DHSS
Medical providers who are precluded from participation in the Medical Assistance Program
United States · DHS
us-medpa-ff429e65d7891cb9939484a42e166c04c60481ab · us-medde-41235e7a69b5d954097abce3d17dfecbbb3eeb71For experts: raw data explorer
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| Address | ||
|---|---|---|
| Full address | Country | |
| Philadelphia, PA | United States | |
| Linked from | ||||
|---|---|---|---|---|
| Subject | Role | Start date | End date | |
| Olalckan Abifarin Debarred entity | - | - | - | |
| United States | Pennsylvania Department of Human services | - | - |