Healthcare Provider Details

I. General information

NPI: 1104976422
Provider Name (Legal Business Name): CTN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HANCOCK AVE
VANDERGRIFT PA
15690-1523
US

IV. Provider business mailing address

701 HANCOCK AVE
VANDERGRIFT PA
15690-1523
US

V. Phone/Fax

Practice location:
  • Phone: 724-568-3691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP413967L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier3954597
Identifier TypeOTHER
Identifier State
Identifier IssuerOTHER ID NUMBER-COMMERCIAL NUMBER

VIII. Authorized Official

Name: DAVID NIDA
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 724-568-3691