=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508677253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLEASANT VALLEY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2025
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1457 ROUTE 209 STE 101A
-----------------------------------------------------
City | BRODHEADSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18322-7153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-992-4839
-----------------------------------------------------
Fax | 570-992-4840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1457 ROUTE 209 STE 101A
-----------------------------------------------------
City | BRODHEADSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18322-7153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-992-4839
-----------------------------------------------------
Fax | 570-992-4840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEVIN PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-992-4839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------