MEDICARE: BRUNDAGE PHARMACIES 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
2	333600000X	Pharmacy	PP482647	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2160099	OTHER		PK

General Provider Information

NPI Number	:	1609223197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUNDAGE PHARMACIES INC.

Provider Business Mailing Address
First Line	:	PO BOX 398
Second Line	:
City	:	WAYMART
State	:	PA
Zip	:	18472-0398
Country	:	US
Telephone Number	:	570-488-7979
Fax Number	:	570-488-7773

Provider Business Practice Location Address
First Line	:	2489 ROUTE 6
Second Line	:
City	:	HAWLEY
State	:	PA
Zip	:	18428-6078
Country	:	US
Telephone Number	:	570-390-7655
Fax Number	:	570-390-7657

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL BRUNDAGE
Credential	:
Telephone Number	:	570-488-7979

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/16/2016

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Directions to “BRUNDAGE PHARMACIES INC. ” Practice Location

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