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General NPI Number Information
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NPI Number | 1023361631
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Entity Type | Organization
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Legal Business Name | MINERSVILLE PHARMACY, INC.
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 106 SUNBURY ST
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City | MINERSVILLE
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State | PA
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Zip | 17954-1443
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Country | US
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Telephone | 570-399-5488
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Fax | 570-399-5490
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Provider Business Mailing Address
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Address Line | 106 SUNBURY ST
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City | MINERSVILLE
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State | PA
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Zip | 17954-1443
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Country | US
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Telephone | 570-399-5488
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Fax | 570-399-5490
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Authorized Official
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Title or Position | MANAGER
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Name | MS. CAROLYN KUSHWARRA
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Credential | R.PH.
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Telephone | 570-399-5488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482314
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License Number State | PA
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