Organization
CENTRE CREST PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN M. LUCKOVICH RPH (PHARMACY MANAGER)
(814) 355-6890
Entity
Organization
Contact information
Practice address
502 E HOWARD ST, BELLEFONTE, PA 16823-2128
(814) 355-6890
(814) 355-6999
Mailing address
502 E HOWARD ST, BELLEFONTE, PA 16823-2128
(814) 355-6890
(814) 355-6999
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
HP416574-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007296630006
—
PA
01
—
HP416574-L
STATE LICENSE NUMBER
PA
Enumeration date
02/26/2007
Last updated
08/22/2020
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