Provider Demographics
NPI:1295888345
Name:PLEASANT HILLS APOTHECARY
Entity type:Organization
Organization Name:PLEASANT HILLS APOTHECARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANCIC
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:412-653-7566
Mailing Address - Street 1:25 GILL HALL RD
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3004
Mailing Address - Country:US
Mailing Address - Phone:412-653-7566
Mailing Address - Fax:412-653-0755
Practice Address - Street 1:25 GILL HALL RD
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3004
Practice Address - Country:US
Practice Address - Phone:412-653-7566
Practice Address - Fax:412-653-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
PAPP413312L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2082322OtherPK
PA0005576640001Medicaid
0743620001Medicare NSC