Healthcare Provider Details

I. General information

NPI: 1831132174
Provider Name (Legal Business Name): PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 ADMIRAL PEARY HWY
EBENSBURG PA
15931-4332
US

IV. Provider business mailing address

4501 ADMIRAL PEARY HWY
EBENSBURG PA
15931-4332
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-0495
  • Fax: 814-472-0572
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP417043L
License Number StatePA

VIII. Authorized Official

Name: CHRISTINE GRIFFITH
Title or Position: CHIEF PHARMACIST
Credential:
Phone: 814-472-0498