Organization
CC BLUE INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
1234 W MAIN ST, MONONGAHELA, PA 15063-2830
(724) 258-5055
(724) 258-7806
Mailing address
1234 W MAIN ST, MONONGAHELA, PA 15063-2830
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP414165L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017521170001
—
PA
01
—
3957719
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
02/21/2007
Last updated
03/07/2023
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