Healthcare Provider Details

I. General information

NPI: 1316150741
Provider Name (Legal Business Name): GREEN PARK HEALTH LLC DBA TROY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 LOWRIE STREET TROY PHARMACY
PITTSBURGH PA
15212
US

IV. Provider business mailing address

1612 LOWRIE STREET
PITTSBURGH PA
15212
US

V. Phone/Fax

Practice location:
  • Phone: 412-904-2231
  • Fax: 412-904-2605
Mailing address:
  • Phone: 412-732-0292
  • Fax: 412-904-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPP482013
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP482013
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482013
License Number StatePA

VIII. Authorized Official

Name: MR. JAMES CONRAD BURKE
Title or Position: GENERAL MANAGER
Credential: RPH RP032893L
Phone: 412-915-3510