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General NPI Number Information
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NPI Number | 1891804951
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Entity Type | Organization
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Legal Business Name | PENN LAUREL PHARMACY, LLC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 112 SUNSHINE AVE
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City | CENTRAL CITY
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State | PA
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Zip | 15926-1129
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Country | US
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Telephone | 814-754-5717
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Fax |
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Provider Business Mailing Address
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Address Line | 112 SUNSHINE AVE
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City | CENTRAL CITY
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State | PA
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Zip | 15926-1129
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Country | US
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Telephone | 814-754-5717
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | JACQUELINE MARTELLA M MARTELLA
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Credential |
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Telephone | 814-754-5717
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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 |
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License Number State | PA
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