MEDICARE: CARUSO DRUG STORE 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	333600000X	Pharmacy	PP412141L	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

General Provider Information

NPI Number	:	1306827746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARUSO DRUG STORE INC

Provider Business Mailing Address
First Line	:	323 BROAD ST
Second Line	:
City	:	NEW BETHLEHEM
State	:	PA
Zip	:	16242-1003
Country	:	US
Telephone Number	:	814-275-1156
Fax Number	:	814-275-4798

Provider Business Practice Location Address
First Line	:	323 BROAD ST
Second Line	:
City	:	NEW BETHLEHEM
State	:	PA
Zip	:	16242-1003
Country	:	US
Telephone Number	:	814-275-1156
Fax Number	:	814-275-4798

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. AUTOINETTE ASTORI CARUSO
Credential	:
Telephone Number	:	814-275-1156

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	08/22/2020

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Directions to “CARUSO DRUG STORE INC ” Practice Location

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