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General NPI Number Information
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NPI Number | 1740325372
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Entity Type | Organization
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Legal Business Name | CC BLUE INC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1234 W MAIN ST
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City | MONONGAHELA
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State | PA
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Zip | 15063-2830
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Country | US
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Telephone | 724-258-5055
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Fax | 724-258-7806
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Provider Business Mailing Address
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Address Line | 1234 W MAIN ST
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City | MONONGAHELA
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State | PA
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Zip | 15063-2830
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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 | THIRD PARTY PLAN COORDINATOR
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Name | DENA FERMAN
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Credential |
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Telephone | 314-993-6000
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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 | PP414165L
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License Number State | PA
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