Organization
MPA PHARMACEUTICAL SERVICES LLC
Active
Other names
FAIRWAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME PRUSACK (OWNER)
(570) 278-8790
Entity
Organization
Contact information
Practice address
16750 SR 706, SUITE 5, MONTROSE, PA 18801-9263
(570) 278-8790
(570) 278-2975
Mailing address
16750 SR 706, SUITE 5, MONTROSE, PA 18801-9263
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP415788L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1857781
—
PA
05
—
2253850
—
OH
01
—
3979347
OTHER ID NUMBER
—
Enumeration date
10/14/2005
Last updated
07/18/2013
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