Organization
AVONELLE, INC
Active
Organization
AVONELLE, INC
Active
Other names
TOMS RIVERSIDE PHARMACY 9775
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS B RAY (PRESIDENT, AVONELLE, INC.)
(814) 226-4038
Entity
Organization
Contact information
Practice address
8868 ROUTE 338, KNOX, PA 16232
(814) 797-2828
(814) 797-2870
Mailing address
8868 ROUTE 338, KNOX, PA 16232
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PP411246L
PA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012693960001
PA PROMISE - MEDICAID
—
05
—
01269396
—
PA
01
—
3963940
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/21/2006
Last updated
11/06/2012
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