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General NPI Number Information
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NPI Number | 1548322852
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Entity Type | Organization
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Legal Business Name | THE MEDICINE MINE INC.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 555 ROUTE 88
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City | CARMICHAELS
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State | PA
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Zip | 15320-1173
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Country | US
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Telephone | 724-966-5237
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Fax |
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Provider Business Mailing Address
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Address Line | 555 ROUTE 88
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City | CARMICHAELS
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State | PA
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Zip | 15320-1173
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Country | US
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Telephone | 724-966-5237
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Fax |
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Authorized Official
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Title or Position | SECT.TREAS
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Name | MRS. CHERIE L ANGELINI
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Credential |
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Telephone | 724-966-5237
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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 | PP412532L
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License Number State | PA
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