Provider Demographics
NPI:1376674473
Name:DAUPHIN PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:DAUPHIN PROFESSIONAL PHARMACY INC
Other - Org Name:DAUPHIN PROFESSIONAL PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSYNYK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-921-8921
Mailing Address - Street 1:722 ALLEGHENY ST
Mailing Address - Street 2:STE 1
Mailing Address - City:DAUPHIN
Mailing Address - State:PA
Mailing Address - Zip Code:17018-8902
Mailing Address - Country:US
Mailing Address - Phone:717-921-8921
Mailing Address - Fax:717-921-8923
Practice Address - Street 1:722 ALLEGHENY ST
Practice Address - Street 2:STE 1
Practice Address - City:DAUPHIN
Practice Address - State:PA
Practice Address - Zip Code:17018-8902
Practice Address - Country:US
Practice Address - Phone:717-921-8921
Practice Address - Fax:717-921-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP411726L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001157380002Medicaid
3958090OtherNCPDP PROVIDER IDENTIFICATION NUMBER