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A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Long Term Care Pharmacy |
3336L0003X | 58 | Medical Supply Company with Pharmacist | |
Community/Retail Pharmacy |
3336C0003X | 58 | Medical Supply Company with Pharmacist |
| NPI # | 1952864951 |
| LBN Legal business name | BROAD STREET PHARMACY, INC |
| Authorized official | TAMARA MASON - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 04/08/2019 |
| Last updated | 11/06/2025 - About 7 months ago |
| Identifiers | n/a |
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BROAD STREET PHARMACY, INC