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General NPI Number Information
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NPI Number | 1871919118
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Entity Type | Organization
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Legal Business Name | EDPHARMALLC
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 123 COLUMBIA DR.
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City | MARSHALLS CREEK
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State | PA
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Zip | 18335
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Country | US
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Telephone | 570-223-2600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1399
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City | MARSHALLS CREEK
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State | PA
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Zip | 18335-1399
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Country | US
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Telephone | 570-223-2600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDMUND POTOCKI
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Credential |
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Telephone | 570-223-2600
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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 | PP4822308
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License Number State | PA
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