Organization
PUNXSY HOMETOWN PHARMACY LLC
Active
Other names
Punxsy Hometown Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NICKOLAS KERNICH (PHARMACY MANAGER/OWNER)
(814) 591-7125
Entity
Organization
Contact information
Practice address
203 HAMPTON AVE, PUNXSUTAWNEY, PA 15767-2133
(814) 938-9150
(814) 938-9151
Mailing address
203 HAMPTON AVE, PUNXSUTAWNEY, PA 15767-2133
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP481900
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022626600001
—
PA
01
—
3991773
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/14/2009
Last updated
08/10/2010
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