Provider Demographics
NPI:1033213723
Name:DAN'S SOUTH HILLS PHARMACY
Entity Type:Organization
Organization Name:DAN'S SOUTH HILLS PHARMACY
Other - Org Name:ASTI'S SOUTH HILLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:412-561-2347
Mailing Address - Street 1:250 MOUNT LEBANON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1252
Mailing Address - Country:US
Mailing Address - Phone:412-561-2347
Mailing Address - Fax:412-561-2503
Practice Address - Street 1:250 MOUNT LEBANON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1252
Practice Address - Country:US
Practice Address - Phone:412-561-2347
Practice Address - Fax:412-561-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2600162Medicaid
PA1013209290001Medicaid
OH2600162Medicaid