MEDICARE: THOMAS GERARD PUPO RPH

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	183500000X	Pharmacist	RP031907L	PA

General Provider Information

NPI Number	:	1750970380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS GERARD PUPO RPH

Provider Business Mailing Address
First Line	:	348 PENNSYLVANIA AVE W STE 1
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2469
Country	:	US
Telephone Number	:	814-723-2840
Fax Number	:	814-723-3830

Provider Business Practice Location Address
First Line	:	348 PENNSYLVANIA AVE W STE 1
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2469
Country	:	US
Telephone Number	:	814-723-2840
Fax Number	:	814-723-3830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	01/18/2021

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Directions to “ THOMAS GERARD PUPO RPH” Practice Location

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