=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487983128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANVILLE PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2009
-----------------------------------------------------
Last Update Date | 03/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 439 MILL ST
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17821-1063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-284-4667
-----------------------------------------------------
Fax | 570-284-4670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 229 MILL ST
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17821-1964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-284-4669
-----------------------------------------------------
Fax | 570-284-4670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. KATHRYN R GRANDIZIO
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 570-284-4667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------