=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497810782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAOLI APOTHECARY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2006
-----------------------------------------------------
Last Update Date | 08/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 W. LANCASTER AVE MOB 1 STE. 107
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-251-2295
-----------------------------------------------------
Fax | 610-251-2294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 255 W. LANCASTER AVE MOB 1 STE. 107
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-251-2295
-----------------------------------------------------
Fax | 610-251-2294
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER/OWNER
-----------------------------------------------------
Name | PAUL BURRICHTER
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 610-251-2295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP481424
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------