Provider Demographics
NPI:1942308598
Name:PPM INC
Entity Type:Organization
Organization Name:PPM INC
Other - Org Name:NORVELT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-423-4100
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:NORVELT
Mailing Address - State:PA
Mailing Address - Zip Code:15674-0391
Mailing Address - Country:US
Mailing Address - Phone:724-423-4100
Mailing Address - Fax:724-424-8082
Practice Address - Street 1:2310 MT. PLEASANT ROAD
Practice Address - Street 2:
Practice Address - City:NORVELT
Practice Address - State:PA
Practice Address - Zip Code:15674
Practice Address - Country:US
Practice Address - Phone:724-423-4100
Practice Address - Fax:724-424-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411708L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005848590001Medicaid
PA3912979OtherNABP#