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General NPI Number Information
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NPI Number | 1679656623
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Entity Type | Organization
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Legal Business Name | RISTWAY INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 144 POST AVENUE
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City | NEW STANTON
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State | PA
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Zip | 15672
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Country | US
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Telephone | 724-925-9810
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Fax | 724-925-1730
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Provider Business Mailing Address
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Address Line | PO BOX 515
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City | NEW STANTON
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State | PA
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Zip | 15672-0515
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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 | PRESIDENT
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Name | SHANE JOSEPH DAUGHERTY
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Credential | PHARMD
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Telephone | 724-925-9810
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP414238L
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License Number State | PA
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