Organization
BRUNDAGE PHARMACIES INC.
Active
Other names
Brundage's Lake Region Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BRUNDAGE (PRESIDENT)
(570) 488-7979
Entity
Organization
Contact information
Practice address
2489 ROUTE 6, HAWLEY, PA 18428-6078
(570) 390-7655
(570) 390-7657
Mailing address
PO BOX 398, WAYMART, PA 18472-0398
(570) 488-7979
(570) 488-7773
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PP482647
PA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160099
PK
—
Enumeration date
05/16/2016
Last updated
05/16/2016
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