Rostraver Drug Store L L C

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP481600 Issued in PA

Legal business name

ROSTRAVER DRUG STORE L L C

Doing business as

Rostraver Drug Store LLC

Practice address

520 Circle Dr
Belle Vernon, PA 15012-9680

Phone

(724) 929-5533

Fax

(724) 929-5530

NPI assigned

Jul 1, 2006

Last updated

Jun 13, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bryan Polomoscanik, RPH

Title

Owner

Phone

(724) 518-4195

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ROSTRAVER DRUG STORE LLC Doing business as

Locations

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465776000000",
    "number": "1174552475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 CIRCLE DR",
            "city": "BELLE VERNON",
            "state": "PA",
            "postal_code": "150129680",
            "telephone_number": "724-929-5533",
            "fax_number": "724-929-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 CIRCLE DR",
            "city": "BELLE VERNON",
            "state": "PA",
            "postal_code": "150129680",
            "telephone_number": "724-929-5533",
            "fax_number": "724-929-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSTRAVER DRUG STORE L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2016-06-13",
        "status": "A",
        "authorized_official_last_name": "POLOMOSCANIK",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-518-4195",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP481600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016655970001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2087835",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ROSTRAVER DRUG STORE LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Samantha L Robinson, CRNP
• Theresa A Rodriguez, RPH
• Rostraver West Newton EMS
• Donald Edward Rowe, D.C.
• Rudberg & Rudberg, LLC (Ronald L. Rudberg Counseling Services)
• Mary R. Rudberg, LPC, CRC, CACD, M.S.
• Brian Rudolph, D.M.D.

• Community/Retail Pharmacy in Belle Vernon, PA
• Providers in Belle Vernon, 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 Jun 13, 2016; 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.