Provider Demographics
NPI:1578885836
Name:DAMCOTT, BRIAN C (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:DAMCOTT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 EAST COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407
Mailing Address - Country:US
Mailing Address - Phone:814-663-7065
Mailing Address - Fax:814-663-8072
Practice Address - Street 1:961 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-9163
Practice Address - Country:US
Practice Address - Phone:814-663-7065
Practice Address - Fax:814-663-8072
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007455310102Medicaid