Organization
EVANS CITY DRUG STORE INC
Active
Organization
EVANS CITY DRUG STORE INC
Active
Other names
EVANS CITY PHARMACY AND GIFT SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY MUSTOVIC RPH (PRESIDENT)
(724) 538-4240
Entity
Organization
Contact information
Practice address
201 E MAIN ST, EVANS CITY, PA 16033-1219
(724) 538-4240
(724) 538-3826
Mailing address
201 E MAIN ST, EVANS CITY, PA 16033-1219
(724) 538-4240
(724) 538-3826
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP412566L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011557890001
—
PA
01
—
2087018
PK
—
Enumeration date
11/07/2006
Last updated
03/13/2017
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