Healthcare Provider Details

I. General information

NPI: 1801878673
Provider Name (Legal Business Name): BUCHANAN BROTHERS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MAIN ST
COUDERSPORT PA
16915-1621
US

IV. Provider business mailing address

101 N MAIN ST
COUDERSPORT PA
16915-1621
US

V. Phone/Fax

Practice location:
  • Phone: 814-274-8660
  • Fax: 814-274-8984
Mailing address:
  • Phone: 814-274-8660
  • Fax: 814-274-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP412324L
License Number StatePA

VIII. Authorized Official

Name: MR. JOSEPH N MARZO
Title or Position: PRESIDENT
Credential: RPH
Phone: 814-274-8660