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General NPI Number Information
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NPI Number | 1508886433
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Entity Type | Organization
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Legal Business Name | MOSHANNON VALLEY PHARMACY INC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 208 MEDICAL CENTER DR
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City | PHILIPSBURG
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State | PA
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Zip | 16866-1948
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Country | US
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Telephone | 814-342-5200
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Fax | 814-342-6749
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Provider Business Mailing Address
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Address Line | 1605 WASHINGTON AVENUE PO BOX 529
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City | HYDE
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State | PA
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Zip | 16843-0529
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Country | US
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Telephone | 814-765-1800
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Fax |
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Authorized Official
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Title or Position | MANAGER OF PHARMACIES
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Name | ROBERT BRANSTETTER
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Credential |
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Telephone | 814-342-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP413567L
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License Number State | PA
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