Organization
BRUNDAGES WAYMART PHARMACY
Active
Other names
BRUNDAGES WAYMART PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BRUNDAGE PHARM D (PRESIDENT PHARMACY MANAGER)
(570) 488-7979
Entity
Organization
Contact information
Practice address
238 BELMONT ST, WAYMART, PA 18472-9310
(570) 488-7979
(570) 488-7773
Mailing address
PO BOX 398, WAYMART, PA 18472-0398
(570) 488-7979
(570) 488-7773
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP415770L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015465050002
—
PA
01
—
3979296
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/10/2006
Last updated
04/20/2017
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