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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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