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General NPI Number Information
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NPI Number | 1356863864
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Entity Type | Organization
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Legal Business Name | TRUTT'S PHARMACY LLC
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 55 WALNUT ST
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City | MIFFLINBURG
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State | PA
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Zip | 17844-1116
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Country | US
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Telephone | 570-966-8788
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Fax | 570-966-8777
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Provider Business Mailing Address
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Address Line | 55 WALNUT ST
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City | MIFFLINBURG
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State | PA
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Zip | 17844-1116
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Country | US
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Telephone | 570-966-8788
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Fax | 570-966-8777
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Authorized Official
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Title or Position | OWNER
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Name | TYLER TRUTT
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Credential | PHARMD
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Telephone | 570-716-9537
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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 | PP482740
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License Number State | PA
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