MEDICARE: SCOTTDALE 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP412228L	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	2080053	OTHER		PK

General Provider Information

NPI Number	:	1316044258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTTDALE PHARMACY INC

Provider Business Mailing Address
First Line	:	222 PITTSBURGH ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1735
Country	:	US
Telephone Number	:	724-887-6870
Fax Number	:	724-887-6422

Provider Business Practice Location Address
First Line	:	222 PITTSBURGH ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1735
Country	:	US
Telephone Number	:	724-887-6870
Fax Number	:	724-887-6422

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARBARA HOFFMAN
Credential	:	RPH
Telephone Number	:	724-887-6870

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/18/2017

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Directions to “SCOTTDALE PHARMACY INC ” Practice Location

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