Provider Demographics
NPI:1609970342
Name:PERRY DRUG STORE LLC
Entity Type:Organization
Organization Name:PERRY DRUG STORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:724-736-4422
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473-0314
Mailing Address - Country:US
Mailing Address - Phone:724-736-4422
Mailing Address - Fax:724-736-0715
Practice Address - Street 1:301 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473-5326
Practice Address - Country:US
Practice Address - Phone:724-736-4422
Practice Address - Fax:724-736-0715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411854L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007112270001Medicaid
PA0007112270001Medicaid