Healthcare Provider Details

I. General information

NPI: 1083609721
Provider Name (Legal Business Name): CALLIGAN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E 4TH AVE
TARENTUM PA
15084-1810
US

IV. Provider business mailing address

412 E 4TH AVE
TARENTUM PA
15084-1810
US

V. Phone/Fax

Practice location:
  • Phone: 724-224-3334
  • Fax: 724-224-4413
Mailing address:
  • Phone: 724-224-3334
  • Fax: 724-224-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP410334L
License Number StatePA

VIII. Authorized Official

Name: MS. AMY M. CAMP
Title or Position: MANAGER
Credential: RPH
Phone: 724-224-3334