Provider Demographics
NPI:1003053091
Name:BLACKBURN'S PHYSICIANS PHARMACY, INC.
Entity Type:Organization
Organization Name:BLACKBURN'S PHYSICIANS PHARMACY, INC.
Other - Org Name:BLACKBURN'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPA
Authorized Official - Phone:724-224-9100
Mailing Address - Street 1:301 CORBET ST
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-5135
Mailing Address - Country:US
Mailing Address - Phone:724-224-9100
Mailing Address - Fax:724-776-0601
Practice Address - Street 1:83 DUTILH RD
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-5135
Practice Address - Country:US
Practice Address - Phone:724-776-0600
Practice Address - Fax:724-776-0601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACKBURN'S PHYSICIANS PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-13
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0175400002Medicare NSC