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General NPI Number Information
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NPI Number | 1497214670
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Entity Type | Organization
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Legal Business Name | BENTLEYVILLE MEDICINE SHOPPE INC
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 03/18/2019
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Provider Practice Location Address
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Address Line | 808 MAIN ST
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City | BENTLEYVILLE
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State | PA
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Zip | 15314-1214
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Country | US
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Telephone | 724-239-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 808 MAIN ST
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City | BENTLEYVILLE
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State | PA
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Zip | 15314-1214
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Country | US
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Telephone | 724-239-3600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN DAVID CRUMRINE
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Credential |
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Telephone | 724-239-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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