MEDICARE: DORAL PHARMACEUTICALS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP415072L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2083965	OTHER		PK

General Provider Information

NPI Number	:	1013938075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORAL PHARMACEUTICALS LLC

Provider Business Mailing Address
First Line	:	799 CASTLE SHANNON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1601
Country	:	US
Telephone Number	:	412-561-2417
Fax Number	:	412-561-7418

Provider Business Practice Location Address
First Line	:	799 CASTLE SHANNON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1601
Country	:	US
Telephone Number	:	412-561-2417
Fax Number	:	412-561-7418

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRUDENCE EVANCIC
Credential	:
Telephone Number	:	412-561-2417

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	11/17/2023

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Directions to “DORAL PHARMACEUTICALS LLC ” Practice Location

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