Provider Demographics
NPI:1780883181
Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Entity type:Organization
Organization Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:814-534-3399
Mailing Address - Street 1:1020 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4109
Mailing Address - Country:US
Mailing Address - Phone:814-534-3399
Mailing Address - Fax:814-534-1088
Practice Address - Street 1:1020 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4109
Practice Address - Country:US
Practice Address - Phone:814-534-3399
Practice Address - Fax:814-534-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X, 333600000X
PAPP4812103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086393OtherPK
3909090002Medicare NSC
PA1007358110127Medicaid