1275002214 NPI number — DARLING APOTHECARY, LLC

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 1275002214 NPI number — DARLING APOTHECARY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARLING APOTHECARY, LLC
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:
6
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:
1275002214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 316
Provider Second Line Business Mailing Address:
17 FOREST ST
Provider Business Mailing Address City Name:
SUGAR GROVE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-723-1743
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 FOREST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-489-7777
Provider Business Practice Location Address Fax Number:
855-456-8155
Provider Enumeration Date:
11/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ZAFFINO
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
BRUNO
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
814-723-1743

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)

  • Identifier: 1012412900003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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