MEDICARE: BUCHANAN BROTHERS PHARMACY INC

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	PP412324L	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	:	1801878673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCHANAN BROTHERS PHARMACY INC

Provider Business Mailing Address
First Line	:	101 N MAIN ST
Second Line	:
City	:	COUDERSPORT
State	:	PA
Zip	:	16915-1621
Country	:	US
Telephone Number	:	814-274-8660
Fax Number	:	814-274-8984

Provider Business Practice Location Address
First Line	:	101 N MAIN ST
Second Line	:
City	:	COUDERSPORT
State	:	PA
Zip	:	16915-1621
Country	:	US
Telephone Number	:	814-274-8660
Fax Number	:	814-274-8984

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH N MARZO
Credential	:	RPH
Telephone Number	:	814-274-8660

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	02/04/2008

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