Most Relevant Information
Provider Data
| NPI Number: | 1003362492 |
| Provider Name: | JOHN MARK |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | RP450812 |
Most Important Dates
| Enumeration Date: | 08/26/2016 |
| Last Updated: | 08/26/2016 |
Provider Practice Location
12050 BUSTLETON AVE
PHILADELPHIA
PA
191162108
Practice Location Phone/Fax
| Phone: | 2156730937 |
| Fax: |
Provider Mailing Location
12050 BUSTLETON AVE
PHILADELPHIA
PA
191162108
Provider Mailing Phone/Fax
| Phone: | 2156730937 |
| Fax: |