Healthcare Provider Details

I. General information

NPI: 1144289299
Provider Name (Legal Business Name): VALENTINE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 N MORGANTOWN ST
FAIRCHANCE PA
15436-1038
US

IV. Provider business mailing address

92 N MORGANTOWN ST
FAIRCHANCE PA
15436-1038
US

V. Phone/Fax

Practice location:
  • Phone: 724-564-1700
  • Fax: 724-564-1704
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481222
License Number StatePA

VIII. Authorized Official

Name: LISA MANGELLO MOLLICA
Title or Position: OWNER
Credential: R PH
Phone: 724-564-1700