| NPI | 1609417070 |
|---|---|
| Doing Business As | BROAD & AMP; GRANGE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | JOHN D IVEY Owner 215-424-2611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2019-10-07 |