Provider Demographics
NPI:1720533243
Name:BIANCARELLIS PHARMACY
Entity Type:Organization
Organization Name:BIANCARELLIS PHARMACY
Other - Org Name:BIANCARELLI'S PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH.
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-382-8570
Mailing Address - Street 1:1318 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2000
Mailing Address - Country:US
Mailing Address - Phone:570-382-8570
Mailing Address - Fax:570-382-3478
Practice Address - Street 1:1318 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2000
Practice Address - Country:US
Practice Address - Phone:570-382-8570
Practice Address - Fax:570-382-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482657333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163909OtherPK