=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699044776
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN T STRAUB PHARM D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2011
-----------------------------------------------------
Last Update Date | 12/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 903 NISSLEY RD
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17601-1472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-406-2226
-----------------------------------------------------
Fax | 866-891-7887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 607 VINE RD
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15857-2035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-335-8680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP445913
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------