Provider Demographics
NPI:1407184807
Name:PRIMARY CARE PHARMACY SERVICES INC.
Entity Type:Organization
Organization Name:PRIMARY CARE PHARMACY SERVICES INC.
Other - Org Name:EXPRESS MED PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BERTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:412-583-6332
Mailing Address - Street 1:27 HECKEL ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCKEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136
Mailing Address - Country:US
Mailing Address - Phone:412-771-2149
Mailing Address - Fax:412-771-2169
Practice Address - Street 1:27 HECKEL ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:MCKEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136
Practice Address - Country:US
Practice Address - Phone:412-771-2149
Practice Address - Fax:412-771-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481981333600000X, 3336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101873732-0003Medicaid
2122901OtherPK