Healthcare Provider Details

I. General information

NPI: 1609223197
Provider Name (Legal Business Name): BRUNDAGE PHARMACIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2489 ROUTE 6
HAWLEY PA
18428-6078
US

IV. Provider business mailing address

PO BOX 398
WAYMART PA
18472-0398
US

V. Phone/Fax

Practice location:
  • Phone: 570-390-7655
  • Fax: 570-390-7657
Mailing address:
  • Phone: 570-488-7979
  • Fax: 570-488-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP482647
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BRUNDAGE
Title or Position: PRESIDENT
Credential:
Phone: 570-488-7979