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General NPI Number Information
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NPI Number | 1376547265
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Entity Type | Organization
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Legal Business Name | FORLENZA'S PHARMACY
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 531 MAIN ST
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City | EDWARDSVILLE
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State | PA
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Zip | 18704-2597
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Country | US
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Telephone | 570-288-6626
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Fax | 570-288-9764
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Provider Business Mailing Address
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Address Line | 531 MAIN ST
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City | EDWARDSVILLE
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State | PA
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Zip | 18704-2597
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Country | US
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Telephone | 570-288-6626
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Fax | 570-288-9764
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. JOHN PAUL FORLENZA
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Credential | P.D.
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Telephone | 570-288-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PP-411080-L
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License Number State | PA
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