Provider Demographics
NPI:1316044258
Name:SCOTTDALE PHARMACY INC
Entity Type:Organization
Organization Name:SCOTTDALE PHARMACY INC
Other - Org Name:SCOTTDALE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-887-6870
Mailing Address - Street 1:222 PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1735
Mailing Address - Country:US
Mailing Address - Phone:724-887-6870
Mailing Address - Fax:724-887-6422
Practice Address - Street 1:222 PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1735
Practice Address - Country:US
Practice Address - Phone:724-887-6870
Practice Address - Fax:724-887-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP412228L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019540500001Medicaid
2080053OtherPK
5118630001Medicare NSC