Provider Demographics
NPI:1588682587
Name:TOWNVILLE INC
Entity Type:Organization
Organization Name:TOWNVILLE INC
Other - Org Name:TOWNVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:570-546-8272
Mailing Address - Street 1:2195 ROUTE 442 HWY
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-7600
Mailing Address - Country:US
Mailing Address - Phone:570-546-8272
Mailing Address - Fax:570-546-6364
Practice Address - Street 1:2195 ROUTE 442 HWY
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-7600
Practice Address - Country:US
Practice Address - Phone:570-546-8272
Practice Address - Fax:570-546-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
PAPP412339L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007770310001Medicaid
2083336OtherPK
PA0007770310001Medicaid