Organization
BROAD AVENUE PHARMACY LLC
Active
Other names
Thompson Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM THOMPSON (PRESIDENT)
(814) 944-6139
Entity
Organization
Contact information
Practice address
2329 BROAD AVE, ALTOONA, PA 16601-1979
(814) 943-1310
(814) 943-2841
Mailing address
2329 BROAD AVE, ALTOONA, PA 16601-1979
(814) 943-1310
(814) 943-2841
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP410249L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019655640001
—
PA
Enumeration date
06/02/2006
Last updated
04/26/2022
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