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General NPI Number Information
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NPI Number | 1316313539
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Entity Type | Organization
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Legal Business Name | PRICE CHOPPER OPERATING CO OF PA INC
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 16750 SR 706
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City | MONTROSE
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State | PA
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Zip | 18801
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Country | US
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Telephone | 570-278-8790
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Fax | 570-278-2975
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Provider Business Mailing Address
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Address Line | 461 NOTT ST
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City | SCHENECTADY
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State | NY
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Zip | 12308-1812
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Country | US
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Telephone | 518-379-1618
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Fax | 518-356-6978
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Authorized Official
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Title or Position | RX 3RD PARTY ADMINISTRATOR
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Name | JESSICA VENNARD
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Credential |
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Telephone | 518-379-1618
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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 | PP415788L
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License Number State | PA
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