Organization
SLOANDALE ENTERPRISES
Active
Other names
The Medicine Shoppe Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CLYDE WILLEY (OWNER)
(814) 827-1849
Entity
Organization
Contact information
Practice address
206 S MARTIN ST, TITUSVILLE, PA 16354-1851
(814) 827-1849
(814) 827-0220
Mailing address
206 S MARTIN ST, TITUSVILLE, PA 16354-1851
(814) 827-1849
(814) 827-0220
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP482649
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103112999
—
PA
01
—
2159091
PK
—
Enumeration date
11/30/2015
Last updated
10/20/2016
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