Provider Demographics
NPI:1831132174
Name:PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Entity Type:Organization
Organization Name:PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Other - Org Name:EBENSBURG CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-472-0498
Mailing Address - Street 1:4501 ADMIRAL PEARY HWY
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4501 ADMIRAL PEARY HWY
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4332
Practice Address - Country:US
Practice Address - Phone:814-472-0495
Practice Address - Fax:814-472-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP417043L333600000X
3336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0743150Medicaid
3951969OtherOTHER ID NUMBER-COMMERCIAL NUMBER