Organization
CRESTWOOD PHARMACY LLC
Active
Other names
Crestwood Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA ORLOSKI (MEMBER)
(570) 474-5859
Entity
Organization
Contact information
Practice address
10 S MOUNTAIN BLVD, MOUNTAIN TOP, PA 18707-1123
(570) 474-5859
(570) 474-9594
Mailing address
10 S MOUNTAIN BLVD, MOUNTAIN TOP, PA 18707-1123
(570) 474-5859
(570) 474-9594
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP410503L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029974200001
—
PA
01
—
2151155
PK
—
Enumeration date
01/08/2015
Last updated
04/13/2017
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