Healthcare Provider Details

I. General information

NPI: 1780666552
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

170 MAIN ST
ELDRED PA
16731-4522
US

IV. Provider business mailing address

170 MAIN ST
ELDRED PA
16731-4522
US

V. Phone/Fax

Practice location:
  • Phone: 814-225-4723
  • Fax: 814-225-4724
Mailing address:
  • Phone: 814-225-4723
  • Fax: 814-225-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP410940L
License Number StatePA

VIII. Authorized Official

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