1659902740 NPI number — MOSHANNON VALLEY PHARMACY INC

Table of content: (NPI 1659902740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659902740 NPI number — MOSHANNON VALLEY PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOSHANNON VALLEY PHARMACY 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:
Provider Other Organization Name Type Code:
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:
1659902740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILIPSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16866-1948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-342-3750
Provider Business Mailing Address Fax Number:
814-342-6323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866-1948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-3750
Provider Business Practice Location Address Fax Number:
814-342-6323
Provider Enumeration Date:
01/28/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FAUST
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
MAX
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
814-684-0230

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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