Healthcare Provider Details

I. General information

NPI: 1205837879
Provider Name (Legal Business Name): BLACKBURNS PHYSICIANS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CORBET ST
TARENTUM PA
15084-1877
US

IV. Provider business mailing address

301 CORBET ST
TARENTUM PA
15084-1877
US

V. Phone/Fax

Practice location:
  • Phone: 724-224-9100
  • Fax: 724-224-6108
Mailing address:
  • Phone: 724-224-9100
  • Fax: 724-224-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP411868L
License Number StatePA

VIII. Authorized Official

Name: MR. RONALD C RUKAS
Title or Position: PRESIDENT/CEO
Credential: RPH
Phone: 724-224-9100