=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891793808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOREST HILLS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2005
-----------------------------------------------------
Last Update Date | 09/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 552 LOCUST ST
-----------------------------------------------------
City | SAINT MICHAEL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15951-0306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-495-9437
-----------------------------------------------------
Fax | 814-495-9848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 306
-----------------------------------------------------
City | SAINT MICHAEL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15951-0306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | RONALD LATTANZIO
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 814-495-9437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP413736L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------