=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710903679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL HOWARD BENDER ESTATE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 03/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3211 4TH AVE
-----------------------------------------------------
City | BEAVER FALLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15010-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-846-1784
-----------------------------------------------------
Fax | 724-846-1795
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3211 4TH AVE
-----------------------------------------------------
City | BEAVER FALLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15010-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-846-1784
-----------------------------------------------------
Fax | 724-846-1795
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | AMY CREA
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 724-846-1784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP410438L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------