Organization
PENN TRAFFIC CO
Active
Organization
PENN TRAFFIC CO
Active
Other names
BILO FOODS AND PHARMACY 9207
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES ERBA RPH (PHARMACY SYSTEMS MANAGER)
(315) 461-2595
Entity
Organization
Contact information
Practice address
1305 E MAIN ST, CLARION, PA 16214-1213
(814) 226-5808
(814) 226-6284
Mailing address
1200 STATE FAIR BLVD, SYRACUSE, NY 13209-1070
(315) 461-2600
(315) 461-2304
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PP415017L
PA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01404006
—
PA
01
—
1007783900044
PA PROMISE- MEDICAID
—
01
—
3969788
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/21/2006
Last updated
06/13/2008
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