Healthcare Provider Details

I. General information

NPI: 1831224252
Provider Name (Legal Business Name): CHICORA PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W SLIPPERY ROCK ST
CHICORA PA
16025
US

IV. Provider business mailing address

100 W. SLIPPERY ROCK ST
CHICORA PA
16025
US

V. Phone/Fax

Practice location:
  • Phone: 724-445-2210
  • Fax: 724-445-2683
Mailing address:
  • Phone: 724-445-2210
  • Fax: 724-445-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP410827L
License Number StatePA

VIII. Authorized Official

Name: LOUIS SCERBO
Title or Position: OWNER
Credential: R.PH.
Phone: 724-445-2210