Provider Demographics
NPI:1013938075
Name:DORAL PHARMACEUTICALS LLC
Entity Type:Organization
Organization Name:DORAL PHARMACEUTICALS LLC
Other - Org Name:KEVIN'S SHOP N SAVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRUDENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-561-2417
Mailing Address - Street 1:799 CASTLE SHANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1601
Mailing Address - Country:US
Mailing Address - Phone:412-561-2417
Mailing Address - Fax:412-561-7418
Practice Address - Street 1:799 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1601
Practice Address - Country:US
Practice Address - Phone:412-561-2417
Practice Address - Fax:412-561-7418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP415072L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101647428001Medicaid
2083965OtherPK
2083965OtherPK
3974917OtherOTHER ID NUMBER-COMMERCIAL NUMBER