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General NPI Number Information
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NPI Number | 1801971718
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Entity Type | Organization
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Legal Business Name | BENSCREEK DRUG STORE
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 133 TIRE HILL RD SUITE 140
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City | JOHNSTOWN
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State | PA
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Zip | 15905-7205
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Country | US
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Telephone | 814-288-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 133 TIRE HILL RD SUITE 140
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City | JOHNSTOWN
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State | PA
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Zip | 15905-7205
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Country | US
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Telephone | 814-288-1800
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Fax |
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Authorized Official
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Title or Position | OWNER, PHARMACIST
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Name | MR. DAVID T SHERIDAN
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Credential | RPH
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Telephone | 814-288-1800
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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 | PP410160L
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License Number State | PA
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