Provider Demographics
NPI:1710903679
Name:DANIEL HOWARD BENDER ESTATE
Entity Type:Organization
Organization Name:DANIEL HOWARD BENDER ESTATE
Other - Org Name:COLLEGE HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:724-846-1784
Mailing Address - Street 1:3211 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-3501
Mailing Address - Country:US
Mailing Address - Phone:724-846-1784
Mailing Address - Fax:724-846-1795
Practice Address - Street 1:3211 4TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-3501
Practice Address - Country:US
Practice Address - Phone:724-846-1784
Practice Address - Fax:724-846-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP410438L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2080124OtherPK
PA0016238170001Medicaid
4727030001Medicare NSC