NPIMap

Organization Active NPI

Penn Traffic Co

Doing business as Bilo Foods and Pharmacy 9207

  • Community/Retail Pharmacy
  • Clarion, PA
National Provider Identifier
1083635304
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PENN TRAFFIC CO
Doing business as
Bilo Foods and Pharmacy 9207
Practice address
1305 E Main St
Clarion, PA 16214-1213
Phone
(814) 226-5808
Fax
(814) 226-6284
NPI assigned
Jul 21, 2006
Last updated
Jun 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

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

Authorized official

Name
James Erba, RPH
Title
Pharmacy Systems Manager
Phone
(315) 461-2595

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PP415017L PA
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1305 E Main St
Clarion, PA 16214-1213

Mailing address

1200 State Fair Blvd
Syracuse, NY 13209-1070
Phone (315) 461-2600

Other identifiers 3

IdentifierTypeStateIssuer
01404006MedicaidPA
3969788OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1007783900044OtherPA PROMISE- MEDICAID

Other names 1

  • BILO FOODS AND PHARMACY 9207 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bilo Foods and Pharmacy 920711 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1305 E Main St
Clarion, PA 16214
Phone (814) 226-5808

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1083635304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 STATE FAIR BLVD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132091070",
            "telephone_number": "315-461-2600",
            "fax_number": "315-461-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 E MAIN ST",
            "city": "CLARION",
            "state": "PA",
            "postal_code": "162141213",
            "telephone_number": "814-226-5808",
            "fax_number": "814-226-6284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN TRAFFIC CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "ERBA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PHARMACY SYSTEMS MANAGER",
        "authorized_official_telephone_number": "315-461-2595",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP415017L",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01404006",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3969788",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA PROMISE- MEDICAID",
            "identifier": "1007783900044",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BILO FOODS AND PHARMACY 9207",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarion, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.