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General NPI Number Information
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NPI Number | 1376680736
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Entity Type | Organization
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Legal Business Name | ROANS PRESCRIPTION DRUG STORE
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 159 E MAIN ST
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City | PLYMOUTH
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State | PA
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Zip | 18651-3018
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Country | US
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Telephone | 570-779-9503
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Fax | 570-779-4889
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Provider Business Mailing Address
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Address Line | 159 E MAIN ST
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City | PLYMOUTH
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State | PA
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Zip | 18651-3018
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Country | US
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Telephone | 570-779-9503
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Fax | 570-779-4889
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Authorized Official
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Title or Position | OWNER
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Name | MR. PAUL M ROAN
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Credential | RPH.
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Telephone | 570-779-9503
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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 | PP412097L
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License Number State | PA
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