Crestwood Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP410503L Issued in PA

Legal business name

CRESTWOOD PHARMACY

Practice address

10 S Mountain Blvd
Mountain Top, PA 18707-1123

Phone

(570) 474-5859

Fax

(570) 474-9594

NPI assigned

Nov 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James Anthony Hanlon, RPH.

Title

Partner, Pharmacist

Phone

(570) 474-5859

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215388800000",
    "number": "1003987686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 S MOUNTAIN BLVD",
            "city": "MOUNTAIN TOP",
            "state": "PA",
            "postal_code": "187071123",
            "telephone_number": "570-474-5859",
            "fax_number": "570-474-9594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 S MOUNTAIN BLVD",
            "city": "MOUNTAIN TOP",
            "state": "PA",
            "postal_code": "187071123",
            "telephone_number": "570-474-5859",
            "fax_number": "570-474-9594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2008-07-07",
        "status": "A",
        "authorized_official_last_name": "HANLON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PARTNER, PHARMACIST",
        "authorized_official_telephone_number": "570-474-5859",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP410503L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000704536",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Mountain Top, PA
• Providers in Mountain Top, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.