Provider Demographics
NPI:1720108756
Name:EVANS CITY APOTHECARY AND WELLNESS CENTER
Entity Type:Organization
Organization Name:EVANS CITY APOTHECARY AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUSTOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-538-3667
Mailing Address - Street 1:122 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EVANS CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16033-1063
Mailing Address - Country:US
Mailing Address - Phone:724-538-3667
Mailing Address - Fax:724-538-3826
Practice Address - Street 1:122 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EVANS CITY
Practice Address - State:PA
Practice Address - Zip Code:16033-1063
Practice Address - Country:US
Practice Address - Phone:724-538-3667
Practice Address - Fax:724-538-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415497L3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy