Healthcare Provider Details

I. General information

NPI: 1518930908
Provider Name (Legal Business Name): GEORGE M. DOPERAK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 PENN AVE
TURTLE CREEK PA
15145-1953
US

IV. Provider business mailing address

920 PENN AVE
TURTLE CREEK PA
15145-1953
US

V. Phone/Fax

Practice location:
  • Phone: 412-824-9920
  • Fax:
Mailing address:
  • Phone: 412-824-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP413354L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3930852
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNCPDP
# 2
Identifier0007483520001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. GEORGE DOPERAK
Title or Position: OWNER
Credential: RPH
Phone: 412-824-9920