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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