Provider Demographics
NPI:1760596159
Name:BONTRAL, INC.
Entity Type:Organization
Organization Name:BONTRAL, INC.
Other - Org Name:UNION CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-438-7570
Mailing Address - Street 1:16395 ROUTE 8
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16438-1501
Mailing Address - Country:US
Mailing Address - Phone:814-438-7570
Mailing Address - Fax:814-438-2229
Practice Address - Street 1:16395 ROUTE 8
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-1501
Practice Address - Country:US
Practice Address - Phone:814-438-7570
Practice Address - Fax:814-438-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415257L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016225980002Medicaid
PA3972545OtherNCPDP
PA3972545OtherNCPDP