Provider Demographics
NPI:1205371218
Name:NORTHWEST PHARMACY SOLUTIONS LLC
Entity Type:Organization
Organization Name:NORTHWEST PHARMACY SOLUTIONS LLC
Other - Org Name:COCHRANTON COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-638-0040
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:
Mailing Address - City:COCHRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:16314-0601
Mailing Address - Country:US
Mailing Address - Phone:814-638-0040
Mailing Address - Fax:814-807-0854
Practice Address - Street 1:180 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:COCHRANTON
Practice Address - State:PA
Practice Address - Zip Code:16314-9706
Practice Address - Country:US
Practice Address - Phone:814-638-0040
Practice Address - Fax:814-638-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4826973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014555360003Medicaid
2166917OtherPK