Healthcare Provider Details

I. General information

NPI: 1356192512
Provider Name (Legal Business Name): SPAN & TAYLOR DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W MAIN ST
MONONGAHELA PA
15063-2305
US

IV. Provider business mailing address

175 W MAIN ST
MONONGAHELA PA
15063-2305
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-4545
  • Fax: 724-258-7909
Mailing address:
  • Phone: 724-258-4545
  • Fax: 724-258-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KRISTOPHER FRANCIS MARCHEWKA
Title or Position: PHARMACY MANAGER
Credential:
Phone: 724-258-4545