Petrolia Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP482155 Issued in PA

Legal business name

PETROLIA PHARMACY INC

Doing business as

Petrolia Pharmacy

Practice address

296 Church Street
Petrolia, PA 16050

Phone

(724) 756-4050

Fax

(724) 756-4060

NPI assigned

Jul 13, 2011

Last updated

May 27, 2022By 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

Bretton WalbergNPI 1659809374

Title

Owner

Phone

(724) 612-2131

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Petrolia Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bretton Clark Walberg, RPH

  • Pharmacist
  • Greenville, PA
  • NPI 1659809374
  Authorized official Same address or phone

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653609600000",
    "number": "1568750388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 MERCER RD",
            "city": "GREENVILLE",
            "state": "PA",
            "postal_code": "161259773",
            "telephone_number": "724-885-0310",
            "fax_number": "330-876-0195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 CHURCH STREET",
            "city": "PETROLIA",
            "state": "PA",
            "postal_code": "16050",
            "telephone_number": "724-756-4050",
            "fax_number": "724-756-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETROLIA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-13",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "WALBERG",
        "authorized_official_first_name": "BRETTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-612-2131"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP482155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2130724",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102748846 0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petrolia Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Petrolia Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edward Balestrino, DO
• Stephen Jeffrey Geibel, PHD
• Carley Renee Gibson
• Karns City Regional Ambulance Service
• Megan Delane Klein, M.S.CCC-SLP
• Petrolia Volunteer Fire Department
• Primary Health Network
• Carl E Shields, RPH
• Soar Pediatric Developmental Therapy, LLC

• Community/Retail Pharmacy in Petrolia, PA
• Providers in Petrolia, 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 May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.