Organization
TRADITIONAL APOTHECARY LLC
Active
Organization
TRADITIONAL APOTHECARY LLC
Active
Other names
TRADITIONAL APOTHECARY
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT CANZANESE (PRESIDENT)
(484) 461-4555
Entity
Organization
Contact information
Practice address
424 N SPRINGFIELD RD, CLIFTON HEIGHTS, PA 19018-1304
(484) 461-4555
(484) 461-4556
Mailing address
PO BOX 232, CLIFTON HEIGHTS, PA 19018-0232
(484) 461-4555
(484) 461-4556
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481812
PA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3990187
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/08/2008
Last updated
06/30/2010
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