Organization
RISTWAY INC
Active
Other names
NEW STANTON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE JOSEPH DAUGHERTY PHARMD (PRESIDENT)
(724) 925-9810
Entity
Organization
Contact information
Practice address
144 POST AVENUE, NEW STANTON, PA 15672
(724) 925-9810
(724) 925-1730
Mailing address
PO BOX 515, NEW STANTON, PA 15672-0515
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP414238L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015787490002
—
PA
01
—
2087301
PK
—
01
—
2B6966
PTAN
—
Enumeration date
10/23/2006
Last updated
12/07/2023
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