Penn Traffic Co

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PENN TRAFFIC CO

Practice address

40 S White St
Brookville, PA 15825-2422

Phone

(814) 849-7548

Fax

(814) 849-9650

NPI assigned

Jul 21, 2006

Organization subpart

No

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

Authorized official

Name

Daniel J Mahoney, ESQ.

Title

SVP/General Counsel

Phone

(315) 461-2347

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• BILO FOODS AND PHARMACY 9201 Doing business as

Locations

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265760000000",
    "number": "1174544498",
    "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": "40 S WHITE ST",
            "city": "BROOKVILLE",
            "state": "PA",
            "postal_code": "158252422",
            "telephone_number": "814-849-7548",
            "fax_number": "814-849-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN TRAFFIC CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2010-02-10",
        "status": "A",
        "authorized_official_last_name": "MAHONEY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SVP/GENERAL COUNSEL",
        "authorized_official_telephone_number": "315-461-2347",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP414919L",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01465807",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3968558",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA PROMISE- MEDICAID",
            "identifier": "1007783900034",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BILO FOODS AND PHARMACY 9201",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Holly A Pangallo, COTA/L
• Dustin Parsons, LPC
• Tanis S Pendleton, MD,PHD
• Timothy Paul Pendleton, MD
• Penn Highlands Home Medical Equipment LLC
• Phoenix Rehabilitation and Health Services, Inc.
• Bruce William Pierson, OD
• Kristi Dawn Powell, RN
• Premier Counseling & Consulting
• Primary Care Associates of Western PA.

• Community/Retail Pharmacy in Brookville, PA
• Providers in Brookville, 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 Feb 10, 2010; 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.