Organization
LORDS VALLEY VILLAGE PHARMACY INC
Active
Other names
LORDS VALLEY VILLAGE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS DOUGHERTY RPH (PRESIDENT)
(570) 499-1900
Entity
Organization
Contact information
Practice address
658 ROUTE 739, SUITE 5, HAWLEY, PA 18428-6086
(570) 775-9555
(570) 775-9593
Mailing address
658 ROUTE 739, SUITE 5, HAWLEY, PA 18428-6086
(570) 775-9555
(570) 775-9593
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP414053L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001126769-0003
—
PA
01
—
2086573
PK
—
Enumeration date
10/12/2006
Last updated
11/21/2018
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