Organization
ROSTRAVER DRUG STORE L L C
Active
Other names
ROSTRAVER DRUG STORE LLC
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN POLOMOSCANIK RPH (OWNER)
(724) 518-4195
Entity
Organization
Contact information
Practice address
520 CIRCLE DR, BELLE VERNON, PA 15012-9680
(724) 929-5533
(724) 929-5530
Mailing address
520 CIRCLE DR, BELLE VERNON, PA 15012-9680
(724) 929-5533
(724) 929-5530
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481600
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016655970001
—
PA
01
—
2087835
PK
—
Enumeration date
07/01/2006
Last updated
06/13/2016
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