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General NPI Number Information
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NPI Number | 1689981060
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Entity Type | Organization
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Legal Business Name | TAMAQUA PHARMACY LLC
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 626 CENTRE ST
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City | ASHLAND
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State | PA
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Zip | 17921-1332
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Country | US
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Telephone | 570-875-1300
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Fax | 570-875-2817
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Provider Business Mailing Address
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Address Line | 626 CENTRE ST
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City | ASHLAND
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State | PA
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Zip | 17921-1332
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Country | US
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Telephone | 570-875-1300
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Fax | 570-875-2817
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Authorized Official
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Title or Position | EXECUTIVE MANAGING MEMBER
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Name | MR. RAJUL PATEL
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Credential |
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Telephone | 404-932-0521
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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 | PP410237L
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License Number State | PA
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