=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184448524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER REED EUTSEY PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2024
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 375 PHILADELPHIA ST
-----------------------------------------------------
City | INDIANA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15701-2068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-465-2243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 194 ROUTE 110 HWY
-----------------------------------------------------
City | INDIANA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15701-8577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-840-3663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP459008
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------