Organization
CHESTNUT RIDGE PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT WAUGERMAN (OWNER)
(814) 839-9950
Entity
Organization
Contact information
Practice address
2262 QUAKER VALLEY RD, FISHERTOWN, PA 15539
(814) 839-9950
Mailing address
PO BOX 95, FISHERTOWN, PA 15539-0095
(814) 839-9950
(814) 839-9952
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481172
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01917280
—
PA
Enumeration date
12/18/2006
Last updated
07/22/2014
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