Provider Demographics
NPI:1669561213
Name:FAMILY PHARMACY OF ARCHBALD INC
Entity type:Organization
Organization Name:FAMILY PHARMACY OF ARCHBALD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-848-1845
Mailing Address - Street 1:4 KELLY ST
Mailing Address - Street 2:KENNEDY PLZ 1
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1627
Mailing Address - Country:US
Mailing Address - Phone:570-876-3312
Mailing Address - Fax:570-876-4251
Practice Address - Street 1:4 KELLY ST
Practice Address - Street 2:KENNEDY PLZ 1
Practice Address - City:ARCHBALD
Practice Address - State:PA
Practice Address - Zip Code:18403-1627
Practice Address - Country:US
Practice Address - Phone:570-876-3312
Practice Address - Fax:570-876-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP414382L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2079923OtherPK
PA01500684Medicaid
PA01500684Medicaid