Healthcare Provider Details

I. General information

NPI: 1619988250
Provider Name (Legal Business Name): JAMES DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 2ND ST
CRESSON PA
16630-1226
US

IV. Provider business mailing address

601 2ND ST
CRESSON PA
16630-1226
US

V. Phone/Fax

Practice location:
  • Phone: 814-886-2266
  • Fax: 814-886-6819
Mailing address:
  • Phone: 814-886-2266
  • Fax: 814-886-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP411146L
License Number StatePA

VIII. Authorized Official

Name: DONALD DELLA
Title or Position: OWNER AND PHARMACIST
Credential: RPH
Phone: 814-886-2266