Healthcare Provider Details

I. General information

NPI: 1497774533
Provider Name (Legal Business Name): MED-FAST PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 SHEFFIELD RD
ALIQUIPPA PA
15001-2758
US

IV. Provider business mailing address

2007 SHEFFIELD RD
ALIQUIPPA PA
15001-2758
US

V. Phone/Fax

Practice location:
  • Phone: 724-375-1672
  • Fax: 724-375-2272
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP481444
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LISA BROSKY
Title or Position: BILLING MANAGER
Credential:
Phone: 724-378-5325