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General NPI Number Information
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NPI Number | 1174544498
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Entity Type | Organization
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Legal Business Name | PENN TRAFFIC CO
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 40 S WHITE ST
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City | BROOKVILLE
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State | PA
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Zip | 15825-2422
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Country | US
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Telephone | 814-849-7548
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Fax | 814-849-9650
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Provider Business Mailing Address
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Address Line | 1200 STATE FAIR BLVD
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City | SYRACUSE
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State | NY
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Zip | 13209-1070
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Country | US
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Telephone | 315-461-2600
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Fax | 315-461-2304
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Authorized Official
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Title or Position | SVP/GENERAL COUNSEL
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Name | DANIEL J MAHONEY
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Credential | ESQ.
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Telephone | 315-461-2347
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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 | PP414919L
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License Number State | PA
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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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