Organization
IMPALA PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT CANZANESE RPH (PRESIDENT)
(484) 482-6274
Entity
Organization
Contact information
Practice address
11 RIDGE BLVD, BROOKHAVEN, PA 19015-2317
(484) 482-6274
(484) 490-6978
Mailing address
11 RIDGE BLVD, BROOKHAVEN, PA 19015-2317
(484) 482-6274
(484) 490-6978
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Enumeration date
08/13/2015
Last updated
08/13/2015
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