MEDICARE: DECARIA BROTHERS INC

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	3336C0003X	Community/Retail Pharmacy	PP413903L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2152704	OTHER		PK

General Provider Information

NPI Number	:	1144225095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECARIA BROTHERS INC

Provider Business Mailing Address
First Line	:	1429 BURGETTSTOWN PLZ
Second Line	:
City	:	BURGETTSTOWN
State	:	PA
Zip	:	15021-1187
Country	:	US
Telephone Number	:	724-947-7000
Fax Number	:	724-947-5699

Provider Business Practice Location Address
First Line	:	1429 BURGETTSTOWN PLZ
Second Line	:
City	:	BURGETTSTOWN
State	:	PA
Zip	:	15021-1187
Country	:	US
Telephone Number	:	724-947-7000
Fax Number	:	724-947-5699

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD DECARIA
Credential	:
Telephone Number	:	412-264-2230

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	12/08/2016

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Directions to “DECARIA BROTHERS INC ” Practice Location

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