Provider Demographics
NPI:1609924851
Name:SOIA LLC
Entity Type:Organization
Organization Name:SOIA LLC
Other - Org Name:BLOOMFIELD DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:412-682-4909
Mailing Address - Street 1:4727 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2025
Mailing Address - Country:US
Mailing Address - Phone:412-682-4909
Mailing Address - Fax:412-682-6696
Practice Address - Street 1:4727 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2025
Practice Address - Country:US
Practice Address - Phone:412-682-4909
Practice Address - Fax:412-682-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410208L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1100711612Medicaid
PA0678450001Medicare NSC