Healthcare Provider Details

I. General information

NPI: 1518901826
Provider Name (Legal Business Name): FAMILY PHARMACY OF OLYPHANT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DELAWARE AVE
OLYPHANT PA
18447-1518
US

IV. Provider business mailing address

110 DELAWARE AVE
OLYPHANT PA
18447-1518
US

V. Phone/Fax

Practice location:
  • Phone: 570-487-4447
  • Fax: 570-487-2750
Mailing address:
  • Phone: 570-487-4447
  • Fax: 570-487-2750

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 NumberPP415636L
License Number StatePA

VIII. Authorized Official

Name: DENNIS DOUGHERTY
Title or Position: PRESIDENT
Credential: RPH
Phone: 570-848-1845