Organization
PENN TRAFFIC CO
Active
Other names
BILO FOODS AND PHARMACY 9201
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL J MAHONEY ESQ. (SVP/GENERAL COUNSEL)
(315) 461-2347
Entity
Organization
Contact information
Practice address
40 S WHITE ST, BROOKVILLE, PA 15825-2422
(814) 849-7548
(814) 849-9650
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
PP414919L
PA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01465807
—
PA
01
—
1007783900034
PA PROMISE- MEDICAID
—
01
—
3968558
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/21/2006
Last updated
02/10/2010
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