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General NPI Number Information
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NPI Number | 1184787889
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Entity Type | Organization
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Legal Business Name | CHESTNUT RIDGE PHARMACY LLC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 2262 QUAKER VALLEY RD
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City | FISHERTOWN
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State | PA
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Zip | 15539
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Country | US
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Telephone | 814-839-9950
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | FISHERTOWN
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State | PA
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Zip | 15539-0095
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Country | US
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Telephone | 814-839-9950
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Fax | 814-839-9952
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT WAUGERMAN
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Credential |
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Telephone | 814-839-9950
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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 | PP481172
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License Number State | PA
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