Organization
OLDE HICKORY PHARMACY INC
Active
Other names
OLDE HICKORY PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYL BON FESSUTO RPH (PRESIDENT CEO HEAD PHARMACIST)
(717) 824-2189
Entity
Organization
Contact information
Practice address
3 WOODHENGE CIR, LITITZ, PA 17543-9096
(717) 431-8429
(717) 569-3807
Mailing address
3 WOODHENGE CIR, LITITZ, PA 17543-9096
(717) 824-2189
(717) 569-3807
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP413656L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205719
—
PA
01
—
3960526
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/10/2006
Last updated
11/08/2011
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