=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659318582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BSDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 07/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 E PHILADELPHIA AVE
-----------------------------------------------------
City | BOYERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19512-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-367-8641
-----------------------------------------------------
Fax | 610-369-0945
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 E PHILADELPHIA AVE
-----------------------------------------------------
City | BOYERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19512-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-367-8641
-----------------------------------------------------
Fax | 610-369-0945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST MANAGER
-----------------------------------------------------
Name | MR. LARRY L MELLOTT
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 610-367-8641
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP410131L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------