Basic Information
| Provider Information | |||||||||
| NPI: | 1508097403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAWLEY | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 CASTOR AVE | ||||||||
| Address2: | TARGET PHARMACY 2075 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191345505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153059051 | ||||||||
| FaxNumber: | 2153059051 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 CASTOR AVE | ||||||||
| Address2: | TARGET PHARMACY 2075 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191345505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153059051 | ||||||||
| FaxNumber: | 2153059051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2009 | ||||||||
| LastUpdateDate: | 07/27/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RP044952L | PA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.