Organization
CHARLES F TRAEGER
Active
Other names
Ayres Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES TRAEGER RPH (OWNER)
(412) 672-3000
Entity
Organization
Contact information
Practice address
3000 WALNUT ST, MCKEESPORT, PA 15132-7158
(412) 672-3000
(412) 672-8983
Mailing address
3000 WALNUT ST, MCKEESPORT, PA 15132-7158
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP410097L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000568505
—
PA
01
—
3919543
OTHER ID NUMBER
—
Enumeration date
08/31/2006
Last updated
06/12/2008
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