Provider Demographics
NPI:1760497382
Name:DARLING APOTHECARY LLC
Entity Type:Organization
Organization Name:DARLING APOTHECARY LLC
Other - Org Name:SPROUT'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:BRUNO
Authorized Official - Last Name:ZAFFINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:814-723-1743
Mailing Address - Street 1:122 E ACADEMY ST
Mailing Address - Street 2:PO BOX 339
Mailing Address - City:SHINGLEHOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:16748-7107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 E ACADEMY ST
Practice Address - Street 2:
Practice Address - City:SHINGLEHOUSE
Practice Address - State:PA
Practice Address - Zip Code:16748-7107
Practice Address - Country:US
Practice Address - Phone:814-697-6331
Practice Address - Fax:814-697-7437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DARLING APOTHECARY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP412364L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2080887OtherPK
PA0012502780002Medicaid
PA0012502780002Medicaid