Healthcare Provider Details

I. General information

NPI: 1235968363
Provider Name (Legal Business Name): AZMAJT RETAIL PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CENTRAL AVE
CANONSBURG PA
15317-1301
US

IV. Provider business mailing address

1 N CENTRAL AVE
CANONSBURG PA
15317-1301
US

V. Phone/Fax

Practice location:
  • Phone: 724-745-6480
  • Fax: 724-916-4957
Mailing address:
  • Phone: 724-745-6480
  • Fax: 724-916-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MISS MAGGIE M OHARE
Title or Position: OWNER
Credential:
Phone: 412-498-0730