Provider Demographics
NPI:1134288459
Name:PRESCRIPTIONS PLUS OF CONNELLSVILLE
Entity Type:Organization
Organization Name:PRESCRIPTIONS PLUS OF CONNELLSVILLE
Other - Org Name:MEDMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUCCINO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-628-7500
Mailing Address - Street 1:2618 MEMORIAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1419
Mailing Address - Country:US
Mailing Address - Phone:724-628-7500
Mailing Address - Fax:724-628-7550
Practice Address - Street 1:2618 MEMORIAL BLVD
Practice Address - Street 2:STE A
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1419
Practice Address - Country:US
Practice Address - Phone:724-628-7500
Practice Address - Fax:724-628-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415760L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016537570001Medicaid
PA3978713OtherNABP
PA3978713OtherNABP