Provider Demographics
NPI:1336639400
Name:BIOCARE INC DBA CANYONCARE RX
Entity Type:Organization
Organization Name:BIOCARE INC DBA CANYONCARE RX
Other - Org Name:CANYONCARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-209-7424
Mailing Address - Street 1:3636 BLVD OF THE ALLIES
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-4306
Mailing Address - Country:US
Mailing Address - Phone:412-209-7424
Mailing Address - Fax:412-209-7281
Practice Address - Street 1:3636 BLVD OF THE ALLIES
Practice Address - Street 2:SUITE 400
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-4306
Practice Address - Country:US
Practice Address - Phone:412-209-7424
Practice Address - Fax:412-209-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
PAPP4827683336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177694OtherPK