=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821018383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C & M PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 E EAGLE RD
-----------------------------------------------------
City | HAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19083-1424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-446-4040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 E EAGLE RD
-----------------------------------------------------
City | HAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19083-1424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-446-4040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MICHAEL D CIONCI
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 610-356-6650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP411200L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------