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General NPI Number Information
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NPI Number | 1528413804
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Entity Type | Organization
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Legal Business Name | YANKEETOWN GOLDEN SPIKE
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 60 YANKEETOWN AVE
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City | HOMER CITY
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State | PA
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Zip | 15748-1011
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Country | US
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Telephone | 724-471-7471
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Fax | 724-471-0262
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Provider Business Mailing Address
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Address Line | 60 YANKEETOWN AVE
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City | HOMER CITY
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State | PA
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Zip | 15748-1011
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Country | US
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Telephone | 724-471-7471
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Fax | 724-471-0262
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Authorized Official
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Title or Position | MANAGER
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Name | TIMOTHY KUNKLE
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Credential | BS, MS, PHARMD
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Telephone | 724-471-7471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | PP482660
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License Number State | PA
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