Healthcare Provider Details

I. General information

NPI: 1730573460
Provider Name (Legal Business Name): NORTHWEST PHARMACY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N MAIN STREET EXT STE 102
MEADVILLE PA
16335-1149
US

IV. Provider business mailing address

740 N MAIN STREET EXT STE 102
MEADVILLE PA
16335-1149
US

V. Phone/Fax

Practice location:
  • Phone: 814-724-3107
  • Fax: 814-807-0854
Mailing address:
  • Phone: 814-724-3107
  • Fax: 814-807-0854

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 NumberPP482508
License Number StatePA

VIII. Authorized Official

Name: STEPHENIE WERNER
Title or Position: ASST. DIR. OF OPS.
Credential:
Phone: 814-724-3107