Organization
SOUTHERN TIER HOME INFUSION INC
Active
Organization
SOUTHERN TIER HOME INFUSION INC
Active
Other names
PHARMACY INNOVATIONS
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD MOON PHARMD (OWNER)
(716) 720-5121
Entity
Organization
Contact information
Practice address
2936 W 17TH ST, ERIE, PA 16505-3929
(814) 838-2102
(716) 708-6248
Mailing address
2535 JOHNS PL, JAMESTOWN, NY 14701-9210
(716) 720-5121
(716) 708-6248
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP481320
PA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1036178670001
—
PA
01
—
2086805
PK
—
Enumeration date
04/25/2007
Last updated
07/13/2022
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