Provider Demographics
NPI:1740262518
Name:BUCHANAN BROTHERS PHARMACY INC
Entity type:Organization
Organization Name:BUCHANAN BROTHERS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARZO
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-274-8660
Mailing Address - Street 1:122 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16950-1522
Mailing Address - Country:US
Mailing Address - Phone:814-367-2327
Mailing Address - Fax:814-367-5197
Practice Address - Street 1:122 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:PA
Practice Address - Zip Code:16950-1522
Practice Address - Country:US
Practice Address - Phone:814-367-2327
Practice Address - Fax:814-367-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411741L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007732690006Medicaid
PA1007732690006Medicaid