MEDICARE: DANIEL HOWARD BENDER ESTATE

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
2	3336C0003X	Community/Retail Pharmacy	PP410438L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2080124	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710903679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL HOWARD BENDER ESTATE

Provider Business Mailing Address
First Line	:	3211 4TH AVE
Second Line	:
City	:	BEAVER FALLS
State	:	PA
Zip	:	15010-3501
Country	:	US
Telephone Number	:	724-846-1784
Fax Number	:	724-846-1795

Provider Business Practice Location Address
First Line	:	3211 4TH AVE
Second Line	:
City	:	BEAVER FALLS
State	:	PA
Zip	:	15010-3501
Country	:	US
Telephone Number	:	724-846-1784
Fax Number	:	724-846-1795

Authorized Official
Title or Position	:	PIC
Name	:	AMY CREA
Credential	:	PHARMD
Telephone Number	:	724-846-1784

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	03/21/2016

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