Provider Demographics
NPI:1467494088
Name:BDT OF SAXTON LLC
Entity Type:Organization
Organization Name:BDT OF SAXTON LLC
Other - Org Name:SAXTON STATION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-635-2221
Mailing Address - Street 1:509 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAXTON
Mailing Address - State:PA
Mailing Address - Zip Code:16678-1050
Mailing Address - Country:US
Mailing Address - Phone:814-635-2221
Mailing Address - Fax:814-635-4004
Practice Address - Street 1:509 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAXTON
Practice Address - State:PA
Practice Address - Zip Code:16678-1050
Practice Address - Country:US
Practice Address - Phone:814-635-2221
Practice Address - Fax:814-635-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP410236L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2080842OtherPK
PA19105933001Medicaid
3925762OtherNCPDP PROVIDER IDENTIFICATION NUMBER