MEDICARE: BLACKBURNS PHYSICIANS PHARMACY 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	PP411868L	PA
2	332B00000X	Durable Medical Equipment & Medical Supplies

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

General Provider Information

NPI Number	:	1205837879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACKBURNS PHYSICIANS PHARMACY INC

Provider Business Mailing Address
First Line	:	301 CORBET ST
Second Line	:
City	:	TARENTUM
State	:	PA
Zip	:	15084-1877
Country	:	US
Telephone Number	:	724-224-9100
Fax Number	:	724-224-6108

Provider Business Practice Location Address
First Line	:	301 CORBET ST
Second Line	:
City	:	TARENTUM
State	:	PA
Zip	:	15084-1877
Country	:	US
Telephone Number	:	724-224-9100
Fax Number	:	724-224-6108

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. RONALD C RUKAS
Credential	:	RPH
Telephone Number	:	724-224-9100

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/03/2012

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