Organization
BLUEGRASS LLC
Active
Other names
BLUEGRASS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA MINAEVA (OWNER)
(215) 676-7650
Entity
Organization
Contact information
Practice address
202 HOLLAND RD STE 230, HOLLAND, PA 18966-1703
(215) 676-7650
(215) 676-8086
Mailing address
202 HOLLAND RD STE 230, HOLLAND, PA 18966-1703
(215) 676-7650
(215) 676-7630
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481659
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10186675001
—
PA
01
—
2081747
PK
—
Enumeration date
12/18/2006
Last updated
01/26/2026
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