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General NPI Number Information
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NPI Number | 1851780795
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Entity Type | Organization
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Legal Business Name | PENNTRUST MEDICAL HOLDINGS LLC
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 175 S MAIN ST UNIT 2
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City | YARDLEY
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State | PA
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Zip | 19067-1623
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Country | US
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Telephone | 267-573-4555
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Fax | 267-573-4966
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Provider Business Mailing Address
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Address Line | 175 S MAIN ST UNIT 2
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City | YARDLEY
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State | PA
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Zip | 19067-1623
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Country | US
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Telephone | 267-573-4555
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Fax | 267-573-4966
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN WILLIAM ROGERS
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Credential | PHARMD
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Telephone | 267-532-7073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482537
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License Number State | PA
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