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General NPI Number Information
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NPI Number | 1801326319
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Entity Type | Organization
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Legal Business Name | FAMILY PHARMACY OF CARBONDALE INC
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Dates
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Enumeration Date | 06/16/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 70 N CHURCH ST
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City | CARBONDALE
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State | PA
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Zip | 18407-1912
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Country | US
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Telephone | 570-281-6300
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Fax | 570-281-6301
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Provider Business Mailing Address
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Address Line | 70 N CHURCH ST
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City | CARBONDALE
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State | PA
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Zip | 18407-1912
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Country | US
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Telephone | 570-281-6300
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Fax | 570-281-6301
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS DOUGHERTY
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Credential |
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Telephone | 570-499-1900
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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 | PP482725
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PP482725
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482725
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License Number State | PA
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