Healthcare Provider Details

I. General information

NPI: 1609970342
Provider Name (Legal Business Name): PERRY DRUG STORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 INDEPENDENCE ST
PERRYOPOLIS PA
15473-5326
US

IV. Provider business mailing address

PO BOX 314
PERRYOPOLIS PA
15473-0314
US

V. Phone/Fax

Practice location:
  • Phone: 724-736-4422
  • Fax: 724-736-0715
Mailing address:
  • Phone: 724-736-4422
  • Fax: 724-736-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP411854L
License Number StatePA

VIII. Authorized Official

Name: MR. LEONARD J PIRILLA
Title or Position: OWNER PRESIDENT
Credential: R PH
Phone: 724-736-4422