Provider Demographics
NPI:1245228477
Name:STARWOOD DRUG INC.
Entity Type:Organization
Organization Name:STARWOOD DRUG INC.
Other - Org Name:MOSSO'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-537-6841
Mailing Address - Street 1:1006 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1837
Mailing Address - Country:US
Mailing Address - Phone:724-537-6841
Mailing Address - Fax:724-539-9486
Practice Address - Street 1:1006 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1837
Practice Address - Country:US
Practice Address - Phone:724-537-6841
Practice Address - Fax:724-539-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411638L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007732310003Medicaid