Organization
VANDERGRIFT PHARMACY LLC
Active
Organization
VANDERGRIFT PHARMACY LLC
Active
Other names
Vandergrift Health Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRETTON WALBERG R.PH. (PRESIDENT)
(724) 612-2131
Entity
Organization
Contact information
Practice address
224 LONGFELLOW ST STE 100, VANDERGRIFT, PA 15690-1476
(724) 567-6615
(724) 568-1608
Mailing address
30 CONNEAUT LAKE RD, GREENVILLE, PA 16125-2167
(724) 567-6615
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PP411945L
PA
3336C0003X
Community/Retail Pharmacy
Primary
PP411945L
PA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007627200001
—
PA
01
—
3942100
NCPDP
PA
Enumeration date
10/21/2006
Last updated
07/14/2026
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