1407184807 NPI number — PRIMARY CARE PHARMACY SERVICES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407184807 NPI number — PRIMARY CARE PHARMACY SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE PHARMACY SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EXPRESS MED PHARMACY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407184807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 HECKEL ROAD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
MCKEES ROCKS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-771-2149
Provider Business Mailing Address Fax Number:
412-771-2169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 HECKEL ROAD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
MCKEES ROCKS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-771-2149
Provider Business Practice Location Address Fax Number:
412-771-2169
Provider Enumeration Date:
11/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BERTOLA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
412-583-6332

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP481981 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X , with the licence number: PP481981 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PP481981 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101873732-0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2122901 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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