Healthcare Provider Details

I. General information

NPI: 1891543690
Provider Name (Legal Business Name): PLEASANT HILLS RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GILL HALL RD STE 2
CLAIRTON PA
15025-3004
US

IV. Provider business mailing address

25 GILL HALL RD STE 2
CLAIRTON PA
15025-3004
US

V. Phone/Fax

Practice location:
  • Phone: 412-653-7566
  • Fax: 412-653-0755
Mailing address:
  • Phone: 412-653-7566
  • Fax: 412-653-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LINETTE M. EVANCIC
Title or Position: SOLE MEMBER
Credential:
Phone: 412-653-7566