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General NPI Number Information
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NPI Number | 1154342483
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Entity Type | Organization
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Legal Business Name | PENN TRAFFIC COMPANY THE
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 152 HARTE HAVEN PLZ
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City | MASSENA
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State | NY
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Zip | 13662-2608
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Country | US
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Telephone | 315-769-0065
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Fax | 315-769-0094
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Provider Business Mailing Address
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Address Line | 152 HARTE HAVEN PLZ
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City | MASSENA
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State | NY
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Zip | 13662-2608
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY SYSTEMS MANAGER
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Name | JAMES ERBA
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Credential | RPH
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Telephone | 315-461-2595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 022287
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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