MEDICARE: DARLING APOTHECARY 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	PP482188	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2130883	OTHER		PK

General Provider Information

NPI Number	:	1023304805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARLING APOTHECARY LLC

Provider Business Mailing Address
First Line	:	212 LIBERTY ST
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2347
Country	:	US
Telephone Number	:	814-723-1743
Fax Number	:	814-726-7876

Provider Business Practice Location Address
First Line	:	17 FOREST ST
Second Line	:
City	:	SUGAR GROVE
State	:	PA
Zip	:	16350-1401
Country	:	US
Telephone Number	:	814-489-7777
Fax Number	:	814-489-7770

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER DARLING
Credential	:
Telephone Number	:	814-688-0113

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	02/21/2017

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