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General NPI Number Information
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NPI Number | 1679655476
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Entity Type | Organization
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Legal Business Name | TIBBOTTS PHARMACY INC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 1104 W HIGH ST STE1, KIMBALL PLAZA
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City | EBENSBURG
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State | PA
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Zip | 15931-1707
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Country | US
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Telephone | 814-472-9390
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Fax | 814-472-1166
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Provider Business Mailing Address
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Address Line | 1104 W HIGH ST BOX 179
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City | EBENSBURG
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State | PA
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Zip | 15931-1707
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROWLAND TIBBOTT
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Credential | RPH
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Telephone | 814-472-9390
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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 | PP412694L
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License Number State | PA
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