MEDICARE: PERRY DRUG STORE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PP411854L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609970342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY DRUG STORE LLC

Provider Business Mailing Address
First Line	:	PO BOX 314
Second Line	:
City	:	PERRYOPOLIS
State	:	PA
Zip	:	15473-0314
Country	:	US
Telephone Number	:	724-736-4422
Fax Number	:	724-736-0715

Provider Business Practice Location Address
First Line	:	301 INDEPENDENCE ST
Second Line	:
City	:	PERRYOPOLIS
State	:	PA
Zip	:	15473-5326
Country	:	US
Telephone Number	:	724-736-4422
Fax Number	:	724-736-0715

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MR. LEONARD J PIRILLA
Credential	:	R PH
Telephone Number	:	724-736-4422

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	05/19/2021

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Directions to “PERRY DRUG STORE LLC ” Practice Location

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