Healthcare Provider Details

I. General information

NPI: 1215034152
Provider Name (Legal Business Name): COUNTY LINE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S YORK RD
HATBORO PA
19040-3231
US

IV. Provider business mailing address

25 S YORK RD
HATBORO PA
19040-3231
US

V. Phone/Fax

Practice location:
  • Phone: 215-443-7700
  • Fax: 215-443-8255
Mailing address:
  • Phone: 215-443-7700
  • Fax: 215-443-8255

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 NumberPP481317
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICK EVES
Title or Position: OWNER
Credential: RPH
Phone: 210-260-8662