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General NPI Number Information
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NPI Number | 1386723054
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Entity Type | Organization
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Legal Business Name | SALEM CROSSROADS APOTHECARY LLC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 195 SHEFFIELD DR STE B
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City | DELMONT
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State | PA
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Zip | 15626-1744
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Country | US
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Telephone | 724-468-5565
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Fax | 724-468-8336
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Provider Business Mailing Address
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Address Line | 195 SHEFFIELD DR STE B
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City | DELMONT
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State | PA
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Zip | 15626-1744
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Country | US
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Telephone | 724-468-5565
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Fax | 724-468-8336
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Authorized Official
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Title or Position | OWNER
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Name | DENNIS JAMES KIESEL
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Credential |
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Telephone | 724-468-5565
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP410636L
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License Number State | PA
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