Provider Demographics
NPI:1700897378
Name:PROVIDENCE PHARMACY SVC LP
Entity Type:Organization
Organization Name:PROVIDENCE PHARMACY SVC LP
Other - Org Name:PROVIDENCE PHARMACY SERVICES LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-352-8822
Mailing Address - Street 1:615 N PIKE RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:PA
Mailing Address - Zip Code:16023-2215
Mailing Address - Country:US
Mailing Address - Phone:724-352-8822
Mailing Address - Fax:724-352-8866
Practice Address - Street 1:615 N PIKE RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:PA
Practice Address - Zip Code:16023-2215
Practice Address - Country:US
Practice Address - Phone:724-352-8822
Practice Address - Fax:724-352-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BN1400X, 333600000X, 3336C0003X, 3336C0004X
PAPP4812173336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086334OtherPK
PA0019280970001Medicaid