=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528120037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORBY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2006
-----------------------------------------------------
Last Update Date | 08/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 626 WATER ST SUITE 3
-----------------------------------------------------
City | ORBISONIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-447-3934
-----------------------------------------------------
Fax | 814-447-3757
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 367
-----------------------------------------------------
City | ORBISONIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17243-0367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-447-3934
-----------------------------------------------------
Fax | 814-447-3757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TYLER SETH RUBY
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 814-447-3934
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP413562L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------