Healthcare Provider Details

I. General information

NPI: 1053317792
Provider Name (Legal Business Name): BLOOMFIELD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W MAIN ST
NEW BLOOMFIELD PA
17068-9603
US

IV. Provider business mailing address

PO BOX 38
NEW BLOOMFIELD PA
17068-0038
US

V. Phone/Fax

Practice location:
  • Phone: 717-582-2313
  • Fax: 717-582-4015
Mailing address:
  • Phone: 717-582-2313
  • Fax: 717-582-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP410209L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN MCCLELLAN
Title or Position: PRES/RPH/OWNER
Credential: BSC PHARM
Phone: 717-582-2313