Provider Demographics
NPI:1639175656
Name:FAMCARE PRESCRIPTION AND HEALTH CENTER OF BURGETTSTOWN, INC.
Entity Type:Organization
Organization Name:FAMCARE PRESCRIPTION AND HEALTH CENTER OF BURGETTSTOWN, INC.
Other - Org Name:FAMCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:724-947-7000
Mailing Address - Street 1:1429 BURGETTSTOWN PLAZA
Mailing Address - Street 2:
Mailing Address - City:BURGETTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15021
Mailing Address - Country:US
Mailing Address - Phone:724-947-7000
Mailing Address - Fax:724-947-5699
Practice Address - Street 1:1429 BURGETTSTOWN PLAZA
Practice Address - Street 2:
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021
Practice Address - Country:US
Practice Address - Phone:724-947-7000
Practice Address - Fax:724-947-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413903L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0340260001Medicare NSC